Provider Demographics
NPI:1568510022
Name:JONES, ROBERT L (OD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
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 1:1101 MELBOURNE RD STE 3002
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-6230
Mailing Address - Country:US
Mailing Address - Phone:817-284-0798
Mailing Address - Fax:817-284-9717
Practice Address - Street 1:1101 MELBOURNE RD STE 3002
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-6230
Practice Address - Country:US
Practice Address - Phone:817-284-0798
Practice Address - Fax:817-284-9717
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4279TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT95913Medicare UPIN
TX8F1091Medicare ID - Type Unspecified