Basic Information
| Provider Information | |||||||||
| NPI: | 1588184204 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JANOUSEK | ||||||||
| FirstName: | ELLIOTT | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7245 E OSBORN RD STE 4 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852516443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809945012 | ||||||||
| FaxNumber: | 4809949479 | ||||||||
| Practice Location | |||||||||
| Address1: | 7245 E OSBORN RD STE 4 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852516443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809945012 | ||||||||
| FaxNumber: | 4809949479 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2017 | ||||||||
| LastUpdateDate: | 11/15/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 9286 | TX | N | Eye and Vision Services Providers | Optometrist | 152W00000X | OPT-002300 | AZ | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.