Individual
NICOLE RENEE JONAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
200 S EXECUTIVE DR, SUITE 101, BROOKFIELD, WI 53005-4216
(888) 964-6681
(888) 662-0859
Mailing address
888 WORCESTER ST, SUITE 130, WELLESLEY, MA 02482-3744
(617) 964-6681
(339) 686-2561
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3014
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38626600
—
WI
01
—
P00224977
RAILROAD MEDICARE
WI
Enumeration date
09/21/2006
Last updated
08/30/2012
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