Provider Demographics
NPI:1376641662
Name:PFLUEGER, JONATHAN JAY (OD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JAY
Last Name:PFLUEGER
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 1:6682 SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4943
Mailing Address - Country:US
Mailing Address - Phone:614-889-4843
Mailing Address - Fax:877-365-3354
Practice Address - Street 1:6682 SAWMILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4943
Practice Address - Country:US
Practice Address - Phone:614-889-4843
Practice Address - Fax:877-365-3354
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4042152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0879296Medicaid
OHPF0689563Medicare PIN
OH0879296Medicaid