Provider Demographics
NPI:1376953042
Name:ISGRIG, JONATHAN RYAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:RYAN
Last Name:ISGRIG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2001 5TH ST
Mailing Address - Street 2:SUITE 49
Mailing Address - City:SILVIS
Mailing Address - State:IL
Mailing Address - Zip Code:61282-2903
Mailing Address - Country:US
Mailing Address - Phone:563-459-6676
Mailing Address - Fax:563-459-6615
Practice Address - Street 1:777 TANGLEFOOT LN
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1650
Practice Address - Country:US
Practice Address - Phone:563-459-6676
Practice Address - Fax:563-459-6615
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010894152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist