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General NPI Number Information
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NPI Number | 1114282548
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Entity Type | Individual
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Provider Name | JONATHON PAUL THOELE O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 02/22/2018
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Provider Practice Location Address
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Address Line | 105 W MAIN ST
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City | MOUNT STERLING
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State | IL
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Zip | 62353-1223
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Country | US
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Telephone | 217-773-3055
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Fax | 217-773-3522
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Provider Business Mailing Address
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Address Line | 2445 BROADWAY ST
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City | QUINCY
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State | IL
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Zip | 62301-3257
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Country | US
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Telephone | 217-222-9207
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Fax | 217-222-9205
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2012025597
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 002553
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046010606
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License Number State | IL
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