Provider Demographics
NPI:1295769008
Name:JASON WONCH, O.D. AND ASSOCIATES, A.P.C.
Entity type:Organization
Organization Name:JASON WONCH, O.D. AND ASSOCIATES, A.P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:504-466-3613
Mailing Address - Street 1:175 E HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2255
Mailing Address - Country:US
Mailing Address - Phone:210-524-6803
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:1401 WEST ESPLANADE BOULEVARD,
Practice Address - Street 2:#208
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065
Practice Address - Country:US
Practice Address - Phone:504-466-3613
Practice Address - Fax:504-461-5354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1448265Medicaid
LA5CJ16Medicare PIN
LA1448265Medicaid