Provider Demographics
NPI:1386636256
Name:FORCHE, JON L (OD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:L
Last Name:FORCHE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 S MILLEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-1251
Mailing Address - Country:US
Mailing Address - Phone:706-543-2020
Mailing Address - Fax:706-549-6618
Practice Address - Street 1:698 S MILLEDGE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-1251
Practice Address - Country:US
Practice Address - Phone:706-543-2020
Practice Address - Fax:706-549-6618
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA1740152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000831377BMedicaid
GA582102247OtherCOMMERCIAL
GA000831377AMedicaid
GA667222OtherBCBS
GA202I410368Medicare PIN
U75909Medicare UPIN
GA000831377BMedicaid