Individual
JONATHON PAUL THOELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
105 W MAIN ST, MOUNT STERLING, IL 62353-1223
(217) 773-3055
(217) 773-3522
Mailing address
2445 BROADWAY ST, QUINCY, IL 62301-3257
(217) 222-9207
(217) 222-9205
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
002553
IA
152W00000X
Optometrist
Primary
046010606
IL
152W00000X
Optometrist
2012025597
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114282548
—
IA
05
—
1114282548
—
IL
05
—
1114282548
—
MO
Enumeration date
07/11/2012
Last updated
02/22/2018
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