=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619115672
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JONATHAN D TSCHANZ,O.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2009
-----------------------------------------------------
Last Update Date | 12/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1265 W MARKET ST
-----------------------------------------------------
City | GERMANTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45327-1715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-855-4121
-----------------------------------------------------
Fax | 937-855-1041
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 238
-----------------------------------------------------
City | GERMANTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45327-0238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-855-4121
-----------------------------------------------------
Fax | 937-855-1041
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JONATHAN D TSCHANZ
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 937-855-4121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 3274
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------