Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 5407T | CA |
Y | 152WP0200X | Pediatric Optomitrist | 5407T | CA |
N | 152WS0006X | Sports Vision | 5407T | CA |
N | 152WV0400X | Optomitrist - Vision Therapist | 5407T | CA |
N | 152WX0102X | Occupational Vision | 5407T | CA |
NPI | 1043312200 |
---|---|
Provider Name | Dr. Donald James Janiuk |
First Address | Poway, CA 92074-0766 |
Second Address | Poway, CA 92064-4529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 28/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T70019 | (02) | CA |