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General NPI Number Information
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NPI Number | 1295684686
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Entity Type | Individual
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Provider Name | JONATHAN WILLIAM FENNELL OD
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Gender | Male
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Dates
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Enumeration Date | 01/27/2026
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 20808 ROUTE 19
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City | CRANBERRY TOWNSHIP
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State | PA
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Zip | 16066-6022
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Country | US
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Telephone | 724-591-8212
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Fax |
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Provider Business Mailing Address
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Address Line | 1014 BRANCHTON RD
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City | BOYERS
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State | PA
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Zip | 16020-1406
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Country | US
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Telephone | 724-496-4936
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Fax |
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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 | OEG004338
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License Number State | PA
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