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General NPI Number Information
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NPI Number | 1780768333
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Entity Type | Individual
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Provider Name | JANSON A MANCHESKI OD
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 11/05/2009
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Provider Practice Location Address
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Address Line | 1244 E GREEN BAY ST JANSON MANCHESKI OD
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City | SHAWANO
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State | WI
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Zip | 54166-2208
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Country | US
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Telephone | 715-526-2376
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Fax | 715-526-9561
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Provider Business Mailing Address
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Address Line | 1244 E GREEN BAY ST JANSON MANCHESKI OD
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City | SHAWANO
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State | WI
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Zip | 54166-2208
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Country | US
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Telephone | 715-526-2376
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Fax | 715-526-9561
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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 | WI1750
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1750
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License Number State | WI
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