Provider Demographics
NPI:1487879714
Name:CONNER, JON TYLER (OD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:TYLER
Last Name:CONNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1801 NW MARKET ST
Mailing Address - Street 2:STE 107
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3909
Mailing Address - Country:US
Mailing Address - Phone:206-324-2006
Mailing Address - Fax:206-223-1963
Practice Address - Street 1:1801 NW MARKET ST
Practice Address - Street 2:STE 107
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3909
Practice Address - Country:US
Practice Address - Phone:206-783-3828
Practice Address - Fax:206-789-2261
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1817TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2008829Medicaid
WA2008829Medicaid
G000109543Medicare ID - Type Unspecified