Provider Demographics
NPI:1003463944
Name:CONNORS, JONATHON DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:JONATHON
Middle Name:DAVID
Last Name:CONNORS
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:PO BOX 19060
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54307-9060
Mailing Address - Country:US
Mailing Address - Phone:920-429-2211
Mailing Address - Fax:
Practice Address - Street 1:1235 S CENTER RD STE 16
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1700
Practice Address - Country:US
Practice Address - Phone:810-744-1950
Practice Address - Fax:810-744-1515
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005364152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist