Healthcare Provider Details

I. General information

NPI: 1801991898
Provider Name (Legal Business Name): JOHN ANDREW SZCZEPANSKI O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 MEADOWYCK DR
LAUREL SPRINGS NJ
08021-4876
US

IV. Provider business mailing address

59 MEADOWYCK DR
LAUREL SPRINGS NJ
08021-4876
US

V. Phone/Fax

Practice location:
  • Phone: 856-783-2023
  • Fax: 856-783-8323
Mailing address:
  • Phone: 856-783-2023
  • Fax: 856-783-8323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00385500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27TO00034200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: