Provider Demographics
NPI:1881969582
Name:DONALD J. JANIUK O.D.
Entity type:Organization
Organization Name:DONALD J. JANIUK O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:JANIUK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:858-748-6210
Mailing Address - Street 1:PO BOX 766
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92074-0766
Mailing Address - Country:US
Mailing Address - Phone:858-748-6210
Mailing Address - Fax:858-748-6224
Practice Address - Street 1:12845 POWAY RD
Practice Address - Street 2:STE 209
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4527
Practice Address - Country:US
Practice Address - Phone:858-748-6210
Practice Address - Fax:858-748-6224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5407TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD003120Medicaid
CAT70019Medicare UPIN
CAOP5407Medicare PIN
CA4386990001Medicare NSC