Healthcare Provider Details

I. General information

NPI: 1750417309
Provider Name (Legal Business Name): JONATHAN S. MCGLOTHAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3498 S 4TH ST
TERRE HAUTE IN
47802-4168
US

IV. Provider business mailing address

PO BOX 1165
EVANSVILLE IN
47706-1165
US

V. Phone/Fax

Practice location:
  • Phone: 877-499-3937
  • Fax:
Mailing address:
  • Phone: 812-471-1591
  • Fax: 812-471-6650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN MCGLOTHAN
Title or Position: OWNER
Credential: MD
Phone: 800-467-2392