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General NPI Number Information
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NPI Number | 1295769008
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Entity Type | Organization
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Legal Business Name | JASON WONCH, O.D. AND ASSOCIATES, A.P.C.
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 07/24/2013
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Provider Practice Location Address
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Address Line | 1401 WEST ESPLANADE BOULEVARD, #208
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City | KENNER
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State | LA
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Zip | 70065
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Country | US
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Telephone | 504-466-3613
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Fax | 504-461-5354
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Provider Business Mailing Address
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Address Line | 175 E HOUSTON ST
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City | SAN ANTONIO
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State | TX
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Zip | 78205-2255
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Country | US
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Telephone | 210-524-6803
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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 | OD
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Telephone | 504-466-3613
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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 |
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License Number State |
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