Individual
JACOB THOMAS JANECEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D
Contact information
Practice address
1865 NW 169TH PL, BEAVERTON, OR 97006-7310
(503) 533-8441
(503) 533-8403
Mailing address
17430 NW SOLANO LN, PORTLAND, OR 97229-2239
(503) 533-8441
(503) 533-8403
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2877AT
OR
152WC0802X
Corneal and Contact Management Optometrist
2877AT
OR
152WP0200X
Pediatric Optometrist
2877AT
OR
152WV0400X
Vision Therapy Optometrist
2877AT
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181435
—
OR
Enumeration date
06/22/2006
Last updated
11/18/2024
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