Healthcare Provider Details

I. General information

NPI: 1467524223
Provider Name (Legal Business Name): JOHN D POLANSKY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 WILLAMETTE STREET
EUGENE OR
97405
US

IV. Provider business mailing address

2460 WILLAMETTE STREET
EUGENE OR
97405
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-3744
  • Fax: 541-683-6672
Mailing address:
  • Phone: 541-683-3744
  • Fax: 541-683-6672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierDG2806
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerRAILROAD MEDICARE
# 2
Identifier006379
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 3
Identifier009139000
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerREGENCE BLUE CROSS
# 4
IdentifierR0000BHFRC
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerMEDICARE

VIII. Authorized Official

Name: KATIE J YOW
Title or Position: FRONT OFFICE LEAD
Credential:
Phone: 541-683-3744