Provider Demographics
NPI:1043379175
Name:KOHLE, JONNA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JONNA
Middle Name:MARIE
Last Name:KOHLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JONNA
Other - Middle Name:MARIE
Other - Last Name:O'CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-0378
Mailing Address - Country:US
Mailing Address - Phone:402-336-2505
Mailing Address - Fax:402-336-3506
Practice Address - Street 1:214 N 10TH ST
Practice Address - Street 2:
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-1604
Practice Address - Country:US
Practice Address - Phone:402-336-2505
Practice Address - Fax:402-336-3506
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1271152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099944001Medicare PIN