Healthcare Provider Details

I. General information

NPI: 1295769008
Provider Name (Legal Business Name): JASON WONCH, O.D. AND ASSOCIATES, A.P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 WEST ESPLANADE BOULEVARD, #208
KENNER LA
70065
US

IV. Provider business mailing address

175 E HOUSTON ST
SAN ANTONIO TX
78205-2255
US

V. Phone/Fax

Practice location:
  • Phone: 504-466-3613
  • Fax: 504-461-5354
Mailing address:
  • Phone: 210-524-6803
  • Fax: 210-524-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: JASON WONCH
Title or Position: OWNER
Credential: OD
Phone: 504-466-3613