Individual
JESSICA MARIE VANEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O. D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
13-0001322
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022837H16
MEDICARE INDIVIDUAL PTAN
DE
01
—
13-0001322
DELAWARE LICENSE
DE
01
—
1578753984
NPI
—
01
—
G00016
MEDICARE GROUP PTAN
DE
Enumeration date
08/01/2007
Last updated
05/18/2011
Update your record
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