Provider Demographics
NPI:1770671349
Name:JASON WONCH OD AND ASSOCIATES A PC
Entity Type:Organization
Organization Name:JASON WONCH OD AND ASSOCIATES A PC
Other - Org Name:VISIONWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WONCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:985-641-8866
Mailing Address - Street 1:PO BOX 849759
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-9759
Mailing Address - Country:US
Mailing Address - Phone:210-524-6663
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:4700 MILLHAVEN ROAD
Practice Address - Street 2:SUITE 1090
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203
Practice Address - Country:US
Practice Address - Phone:318-325-4598
Practice Address - Fax:318-325-4924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4988960014Medicare NSC