Provider Demographics
NPI:1720133036
Name:JANOVITCH, NICOLE MONICA (OD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MONICA
Last Name:JANOVITCH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 E ARQUES AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-5421
Mailing Address - Country:US
Mailing Address - Phone:408-245-2020
Mailing Address - Fax:408-245-2520
Practice Address - Street 1:1210 E ARQUES AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-5421
Practice Address - Country:US
Practice Address - Phone:408-245-2020
Practice Address - Fax:408-245-2520
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12056T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU79630Medicare UPIN
ZZZ01708ZMedicare ID - Type Unspecified