Provider Demographics
NPI:1285694174
Name:JONES, ERIC BRENDON (OD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:BRENDON
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 1:2840 HWY. 95
Mailing Address - Street 2:SUITE #108
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442
Mailing Address - Country:US
Mailing Address - Phone:928-758-2020
Mailing Address - Fax:928-758-4544
Practice Address - Street 1:2840 HWY. 95
Practice Address - Street 2:SUITE #108
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442
Practice Address - Country:US
Practice Address - Phone:928-758-2020
Practice Address - Fax:928-758-4544
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1499152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1285694174OtherNPI
AZZ114997OtherPTAN
AZZ114980OtherPTAN
AZ1760692768OtherNPI
AZZ114980OtherPTAN