MEDICARE: DR. JONATHAN WILLIAM FENNELL OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG004338	PA

General Provider Information

NPI Number	:	1295684686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN WILLIAM FENNELL OD

Provider Business Mailing Address
First Line	:	1014 BRANCHTON RD
Second Line	:
City	:	BOYERS
State	:	PA
Zip	:	16020-1406
Country	:	US
Telephone Number	:	724-496-4936
Fax Number	:

Provider Business Practice Location Address
First Line	:	20808 ROUTE 19
Second Line	:
City	:	CRANBERRY TOWNSHIP
State	:	PA
Zip	:	16066-6022
Country	:	US
Telephone Number	:	724-591-8212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	02/03/2026

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