Provider Demographics
NPI:1982600722
Name:LANCZKI, PAUL W (OD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:LANCZKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:580 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1543
Mailing Address - Country:US
Mailing Address - Phone:517-265-6055
Mailing Address - Fax:517-265-6115
Practice Address - Street 1:1136 COUNTRY CLUB RD
Practice Address - Street 2:UNIT C
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-8209
Practice Address - Country:US
Practice Address - Phone:517-265-6055
Practice Address - Fax:517-265-6115
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002974152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist