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General NPI Number Information
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NPI Number | 1114014628
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Entity Type | Organization
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Legal Business Name | JASON WONCH OD AND ASSOCIATES A P C
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 01/08/2013
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Provider Practice Location Address
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Address Line | 5725 JOHNSTON ST
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City | LAFAYETTE
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State | LA
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Zip | 70503-5307
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Country | US
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Telephone | 318-989-2020
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Fax | 318-989-2094
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Provider Business Mailing Address
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Address Line | PO BOX 849759
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City | DALLAS
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State | TX
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Zip | 75284-9759
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Country | US
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Telephone | 210-524-6663
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Fax | 210-524-6587
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Authorized Official
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Title or Position | OWNER
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Name | JASON WONCH
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Credential | O.D.
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Telephone | 985-641-8866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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