Provider Demographics
NPI:1063587327
Name:JONES, DOUGLAS CHALLENOR (OD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:CHALLENOR
Last Name:JONES
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 1:928 FALLING WATER RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3554
Mailing Address - Country:US
Mailing Address - Phone:954-636-2230
Mailing Address - Fax:
Practice Address - Street 1:1801 PALM BEACH LAKES BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2020
Practice Address - Country:US
Practice Address - Phone:561-683-5710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2773152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6208215Medicaid
FL6208215Medicaid
FL20712Medicare ID - Type Unspecified