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General NPI Number Information
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NPI Number | 1154327435
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Entity Type | Individual
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Provider Name | JONATHAN J DORN OD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 11/13/2019
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Provider Practice Location Address
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Address Line | 1206 ROUTE 72 W
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City | MANAHAWKIN
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State | NJ
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Zip | 08050-2414
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Country | US
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Telephone | 609-597-8087
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Fax | 609-597-7192
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Provider Business Mailing Address
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Address Line | 1206 ROUTE 72 W
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City | MANAHAWKIN
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State | NJ
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Zip | 08050-2414
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Country | US
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Telephone | 609-597-8087
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Fax | 609-597-7192
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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 | 27OM00013700
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License Number State | NJ
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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 | 27OA00505500
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License Number State | NJ
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