Provider Demographics
NPI:1992754246
Name:MC GEORGE, JANICE MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:MARIE
Last Name:MC GEORGE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:MARIE
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:817 COURT ST STE 10
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-2156
Mailing Address - Country:US
Mailing Address - Phone:209-223-2020
Mailing Address - Fax:
Practice Address - Street 1:817 COURT ST STE 10
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2156
Practice Address - Country:US
Practice Address - Phone:209-223-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12642T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0126421Medicaid
CAV04384Medicare UPIN
CASD0126421Medicaid
COSD0126422Medicare PIN