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General NPI Number Information
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NPI Number | 1730231838
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Entity Type | Organization
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Legal Business Name | JOHN D POLANSKY MD PC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 03/15/2011
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Provider Practice Location Address
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Address Line | 2460 WILLAMETTE ST
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City | EUGENE
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State | OR
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Zip | 97405-3169
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Country | US
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Telephone | 541-683-3746
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Fax | 541-683-3747
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Provider Business Mailing Address
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Address Line | 2460 WILLAMETTE ST
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City | EUGENE
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State | OR
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Zip | 97405-3169
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Country | US
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Telephone | 541-683-3746
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Fax | 541-683-3747
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Authorized Official
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Title or Position | OPTICIAN
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Name | SUE STONEBURNER
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Credential |
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Telephone | 541-683-3746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 051837-85
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License Number State | OR
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