Provider Demographics
NPI:1245540046
Name:MATHER, JONATHAN D
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:D
Last Name:MATHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1987 N CARSON ST
Mailing Address - Street 2:STE 5
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-1262
Mailing Address - Country:US
Mailing Address - Phone:775-359-2020
Mailing Address - Fax:775-359-2676
Practice Address - Street 1:1987 N CARSON ST
Practice Address - Street 2:STE 5
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-1262
Practice Address - Country:US
Practice Address - Phone:775-883-2015
Practice Address - Fax:775-359-2676
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV776152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1245540046Medicaid
NVV37415Medicare PIN