Doctor Name: | ROBERT H JANSEN |
NPI Number: | 1063632412 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 2121 W Roosevelt Rd Broadview, IL - 601553850 |
Business Phone Number: | 7083457777 |
Business Fax Number: | |
Mailing Address: | 2121 W Roosevelt Rd, BROADVIEW |
State: | IL |
Postal Code: | 601553850 |
Phone Number: | 7083457777 |
Fax Number: | |
NPI Enumeration Date: | 04/26/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |