Provider Demographics
NPI:1366415663
Name:JANSON, PATRICK ALLAN (OD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:ALLAN
Last Name:JANSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 267119
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43226-7119
Mailing Address - Country:US
Mailing Address - Phone:614-864-0641
Mailing Address - Fax:614-864-2904
Practice Address - Street 1:50 MCNAUGHTEN RD
Practice Address - Street 2:STE 200
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2120
Practice Address - Country:US
Practice Address - Phone:614-863-3937
Practice Address - Fax:614-863-5010
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4651152W00000X
OHT1426152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000036349OtherANTHEM
OH2337626Medicaid
U73073Medicare UPIN
OH2337626Medicaid
OHJA0858372Medicare ID - Type Unspecified
OH0858373Medicare PIN