=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982600722
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL W LANCZKI OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2005
-----------------------------------------------------
Last Update Date | 11/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 580 RIVERSIDE AVE
-----------------------------------------------------
City | ADRIAN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49221-1543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-265-6055
-----------------------------------------------------
Fax | 517-265-6115
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 580 RIVERSIDE AVE
-----------------------------------------------------
City | ADRIAN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49221-1543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-265-6055
-----------------------------------------------------
Fax | 517-265-6115
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 4901002974
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------