Provider Demographics
NPI:1518245356
Name:TONOZZI, JACOB JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:JOHN
Last Name:TONOZZI
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 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35786 ATLANTIC AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:DE
Practice Address - Zip Code:19967-6955
Practice Address - Country:US
Practice Address - Phone:302-537-0234
Practice Address - Fax:302-537-0279
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI3-0001378152W00000X, 152W00000X
CO2863152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist