Provider Demographics
NPI:1639152580
Name:ASHBAKER, JONATHAN CHARLES (OD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:CHARLES
Last Name:ASHBAKER
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 1:8217 E MILL PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-2004
Mailing Address - Country:US
Mailing Address - Phone:360-695-3829
Mailing Address - Fax:360-695-7718
Practice Address - Street 1:8217 E MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2004
Practice Address - Country:US
Practice Address - Phone:360-695-3829
Practice Address - Fax:360-695-7718
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD 3779152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2027217Medicaid
WA2027217Medicaid
WA4978250001Medicare NSC
WAGAB34972Medicare PIN