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General NPI Number Information
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NPI Number | 1205813524
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Entity Type | Individual
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Provider Name | STEPHAN CARL JANKOWSKI OD
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Gender | Male
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 01/05/2009
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Provider Practice Location Address
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Address Line | 93 S MORSE ST
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City | SANDUSKY
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State | MI
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Zip | 48471-0208
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Country | US
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Telephone | 810-648-2456
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Fax | 810-648-5279
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Provider Business Mailing Address
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Address Line | PO BOX 208
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City | SANDUSKY
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State | MI
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Zip | 48471-0208
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Country | US
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Telephone | 810-648-2456
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Fax | 810-648-5279
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901002858
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License Number State | MI
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