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General NPI Number Information
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NPI Number | 1871231084
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Entity Type | Individual
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Provider Name | JONAH MITCHELL RESNICK O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/26/2022
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Last Update Date | 07/07/2022
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Provider Practice Location Address
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Address Line | 17690 KENWOOD TRL
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City | LAKEVILLE
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State | MN
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Zip | 55044-9764
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Country | US
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Telephone | 952-898-9588
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Fax |
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Provider Business Mailing Address
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Address Line | 12500 MARION LN W APT 4125
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City | HOPKINS
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State | MN
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Zip | 55305-1327
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Country | US
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Telephone | 952-200-6121
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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 | 3785
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License Number State | MN
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