Provider Demographics
NPI:1447700240
Name:JASON WONCH, O.D. AND ASSOCIATES, A P.C.
Entity type:Organization
Organization Name:JASON WONCH, O.D. AND ASSOCIATES, A P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WONCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:985-641-8866
Mailing Address - Street 1:175 E. HOUSTON STREET
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2255
Mailing Address - Country:US
Mailing Address - Phone:210-524-6982
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:27306 CROSSING CIRCLE
Practice Address - Street 2:STE. 270
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-5887
Practice Address - Country:US
Practice Address - Phone:225-665-6637
Practice Address - Fax:225-665-8289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier