Provider Demographics
NPI:1801991898
Name:SZCZEPANSKI, JOHN ANDREW (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDREW
Last Name:SZCZEPANSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 MEADOWYCK DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL SPRINGS
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-4876
Mailing Address - Country:US
Mailing Address - Phone:856-783-2023
Mailing Address - Fax:856-783-8323
Practice Address - Street 1:59 MEADOWYCK DR
Practice Address - Street 2:
Practice Address - City:LAUREL SPRINGS
Practice Address - State:NJ
Practice Address - Zip Code:08021-4876
Practice Address - Country:US
Practice Address - Phone:856-783-2023
Practice Address - Fax:856-783-8323
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00385500152W00000X
NJ27TO00034200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1481207Medicaid
NJ1481207Medicaid
NJ034424Medicare PIN