Provider Demographics
NPI:1871946525
Name:MENNUCCI, JONATHAN ERIC (OD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ERIC
Last Name:MENNUCCI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 BRUCE RD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7941
Mailing Address - Country:US
Mailing Address - Phone:530-891-1900
Mailing Address - Fax:530-895-1664
Practice Address - Street 1:1700 BRUCE RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7941
Practice Address - Country:US
Practice Address - Phone:530-891-1900
Practice Address - Fax:530-895-1531
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33519152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist