MEDICARE: DR. KELLY NICOLE JANOS 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	4901005632	MI

General Provider Information

NPI Number	:	1548990922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY NICOLE JANOS OD

Provider Business Mailing Address
First Line	:	4251 N MCNAY CT
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-2838
Country	:	US
Telephone Number	:	248-421-4362
Fax Number	:

Provider Business Practice Location Address
First Line	:	3160 S ROCHESTER RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-5040
Country	:	US
Telephone Number	:	248-853-4141
Fax Number	:

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

Provider Enumeration Date	:	06/16/2022
Last Update Date	:	06/16/2022

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