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General NPI Number Information
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NPI Number | 1194386367
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Entity Type | Individual
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Provider Name | JONATHAN AVERY JUAREZ O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2019
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Last Update Date | 06/27/2019
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Provider Practice Location Address
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Address Line | 4501 JOE RAMSEY BLVD E STE 110
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City | GREENVILLE
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State | TX
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Zip | 75401-7838
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Country | US
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Telephone | 903-454-1886
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Fax | 903-455-3055
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Provider Business Mailing Address
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Address Line | PO BOX 8457
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City | GREENVILLE
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State | TX
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Zip | 75404-8457
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Country | US
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Telephone | 903-454-1886
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Fax | 903-455-3055
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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 | 9739T
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License Number State | TX
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