Healthcare Provider Details

I. General information

NPI: 1558953935
Provider Name (Legal Business Name): JANELLE SVENTEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 UNIVERSITY BLVD G080A
BIRMINGHAM AL
35294-0010
US

IV. Provider business mailing address

2014 W HURON ST APT 1R
CHICAGO IL
60612-1662
US

V. Phone/Fax

Practice location:
  • Phone: 205-975-2020
  • Fax: 205-934-6755
Mailing address:
  • Phone: 239-249-1532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3713
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberR-357-TA-D45
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: