Provider Demographics
NPI:1386166395
Name:CREECH, JONATHAN JAMES (OD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:JAMES
Last Name:CREECH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:JONATHAN
Other - Middle Name:JAMES
Other - Last Name:CREECH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:25439 BLACKTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-5327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41257 MAGARITA ROAD
Practice Address - Street 2:SUITE B 103
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591
Practice Address - Country:US
Practice Address - Phone:951-587-2333
Practice Address - Fax:951-587-2335
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT33734TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty