Individual
DR. JONATHAN TYLER THAYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1894 WENTZVILLE PKWY, WENTZVILLE, MO 63385-3820
(636) 887-4000
(636) 887-4095
Mailing address
15933 CLAYTON RD, BALLWIN, MO 63011-2172
(636) 200-4393
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2024019038
MO
Other
Enumeration date
05/09/2023
Last updated
05/21/2025
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