Provider Demographics
NPI:1063484566
Name:SCHORN, JONATHAN JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JAMES
Last Name:SCHORN
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 1:16105 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-7213
Mailing Address - Country:US
Mailing Address - Phone:952-985-6467
Mailing Address - Fax:952-985-6468
Practice Address - Street 1:16105 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-7213
Practice Address - Country:US
Practice Address - Phone:952-985-6467
Practice Address - Fax:952-985-6468
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN2750152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU76135Medicare UPIN
MN410002178Medicare ID - Type Unspecified