Basic Information
| Provider Information | |||||||||
| NPI: | 1518245356 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TONOZZI | ||||||||
| FirstName: | JACOB | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 OLD GALLOWS RD STE 520 | ||||||||
| Address2: | |||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221823970 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 35786 ATLANTIC AVE UNIT 1 | ||||||||
| Address2: | |||||||||
| City: | MILLVILLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199676955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3025370234 | ||||||||
| FaxNumber: | 3025370279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2011 | ||||||||
| LastUpdateDate: | 03/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | I3-0001378 | DE | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.