Provider Demographics
NPI:1295807626
Name:PAUL W. LANCZKI, P.C. DBA ADRIAN EYECARE & OPTICAL
Entity type:Organization
Organization Name:PAUL W. LANCZKI, P.C. DBA ADRIAN EYECARE & OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-265-6055
Mailing Address - Street 1:1136 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-8208
Mailing Address - Country:US
Mailing Address - Phone:517-265-6055
Mailing Address - Fax:517-265-6115
Practice Address - Street 1:580 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1543
Practice Address - Country:US
Practice Address - Phone:517-265-6055
Practice Address - Fax:517-265-6115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004286332H00000X
MI4901002974332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI864639178Medicaid
MI5276880001OtherDMERC