Organization
JOHN D POLANSKY MD PC
Active
Other names
The Spectacle Shop
Organization subpart
No
Provider details
NPI number
Authorized official
SUE STONEBURNER (OPTICIAN)
(541) 683-3746
Entity
Organization
Contact information
Practice address
2460 WILLAMETTE ST, EUGENE, OR 97405-3169
(541) 683-3746
(541) 683-3747
Mailing address
2460 WILLAMETTE ST, EUGENE, OR 97405-3169
(541) 683-3746
(541) 683-3747
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
051837-85
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0720730001
DMERC
OR
Enumeration date
01/17/2007
Last updated
03/15/2011
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