Provider Demographics
NPI:1770672255
Name:CHON, JESSE I (OD)
Entity Type:Individual
Prefix:MRS
First Name:JESSE
Middle Name:I
Last Name:CHON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29307 NE 85TH CIR
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7058
Mailing Address - Country:US
Mailing Address - Phone:360-600-6939
Mailing Address - Fax:
Practice Address - Street 1:29307 NE 85TH CIR
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-7058
Practice Address - Country:US
Practice Address - Phone:360-600-6939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3726152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist