MEDICARE: DR. JOEL SCOTT JANSEN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3226	WA

General Provider Information

NPI Number	:	1558353862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL SCOTT JANSEN OD

Provider Business Mailing Address
First Line	:	1314 72ND ST E
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98404-3343
Country	:	US
Telephone Number	:	253-531-5535
Fax Number	:	253-531-5535

Provider Business Practice Location Address
First Line	:	1314 72ND ST E
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98404-3343
Country	:	US
Telephone Number	:	253-531-5535
Fax Number	:	253-531-5535

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	07/08/2007

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