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NPI Code Detail

MEDICARE: JANSON A MANCHESKI OD

MEDICARE: JANSON A MANCHESKI 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
1152W00000XOptometristWI1750WI
2152W00000XOptometrist1750WI

General Provider Information

NPI Number : 1780768333
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANSON A MANCHESKI OD
Provider Business Mailing Address
First Line : 1244 E GREEN BAY ST
Second Line : JANSON MANCHESKI OD
City : SHAWANO
State : WI
Zip : 54166-2208
Country : US
Telephone Number : 715-526-2376
Fax Number : 715-526-9561
Provider Business Practice Location Address
First Line : 1244 E GREEN BAY ST
Second Line : JANSON MANCHESKI OD
City : SHAWANO
State : WI
Zip : 54166-2208
Country : US
Telephone Number : 715-526-2376
Fax Number : 715-526-9561
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2006
Last Update Date : 11/05/2009

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