Provider Demographics
NPI:1871231084
Name:RESNICK, JONAH MITCHELL (OD)
Entity Type:Individual
Prefix:DR
First Name:JONAH
Middle Name:MITCHELL
Last Name:RESNICK
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 1:12500 MARION LN W APT 4125
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1327
Mailing Address - Country:US
Mailing Address - Phone:952-200-6121
Mailing Address - Fax:
Practice Address - Street 1:17690 KENWOOD TRL
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-9764
Practice Address - Country:US
Practice Address - Phone:952-898-9588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3785152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty