MEDICARE: DR. PATRICK ALLAN JANSON OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4651	OH
2	152W00000X	Optometrist	T1426	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000036349	OTHER	OH	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366415663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK ALLAN JANSON OD

Provider Business Mailing Address
First Line	:	PO BOX 267119
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43226-7119
Country	:	US
Telephone Number	:	614-864-0641
Fax Number	:	614-864-2904

Provider Business Practice Location Address
First Line	:	50 MCNAUGHTEN RD
Second Line	:	STE 200
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2120
Country	:	US
Telephone Number	:	614-863-3937
Fax Number	:	614-863-5010

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	01/05/2009

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