Basic Information
| Provider Information | |||||||||
| NPI: | 1447700240 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JASON WONCH, O.D. AND ASSOCIATES, A P.C. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VISIONWORKS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 E. HOUSTON STREET | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782052255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105246982 | ||||||||
| FaxNumber: | 2105246587 | ||||||||
| Practice Location | |||||||||
| Address1: | 27306 CROSSING CIRCLE | ||||||||
| Address2: | STE. 270 | ||||||||
| City: | DENHAM SPRINGS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707265887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256656637 | ||||||||
| FaxNumber: | 2256658289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2016 | ||||||||
| LastUpdateDate: | 10/05/2016 | ||||||||
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| AuthorizedOfficialLastName: | WONCH | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9856418866 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
No ID Information.