Provider Demographics
NPI:1932580537
Name:MENOS, JONATHAN GEORGE (OD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:GEORGE
Last Name:MENOS
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 1:1255 APPLETON RD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1501
Mailing Address - Country:US
Mailing Address - Phone:920-722-6872
Mailing Address - Fax:920-722-6335
Practice Address - Street 1:115 ALPINE CT
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-2048
Practice Address - Country:US
Practice Address - Phone:715-526-3163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3378-35152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist