Provider Demographics
NPI:1487651048
Name:JONES, REGINALD HENRY (OD)
Entity type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:HENRY
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:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05033-0325
Mailing Address - Country:US
Mailing Address - Phone:802-222-4543
Mailing Address - Fax:802-222-4503
Practice Address - Street 1:331 UPPER PLN
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:VT
Practice Address - Zip Code:05033-9207
Practice Address - Country:US
Practice Address - Phone:802-222-4543
Practice Address - Fax:802-222-4503
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030-0000195152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT6617OtherBLUE CROSS
NH0900621YOVT03OtherBLUE CROSS
NH30007992Medicaid
VT0006617Medicaid
NH0900621YOVT03OtherBLUE CROSS