Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4901005364 | MI |
NPI | 1003463944 |
---|---|
Provider Name | Dr. Jonathon David Connors |
First Address | Green Bay, WI 54307-9060 |
Second Address | Burton, MI 48509-1700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2019 |
Last Update Date | 10/09/2021 |