Provider Demographics
NPI:1699947416
Name:JONES OPTICAL, PA
Entity type:Organization
Organization Name:JONES OPTICAL, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:903-758-9090
Mailing Address - Street 1:2304 JUDSON RD
Mailing Address - Street 2:STE B
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-4673
Mailing Address - Country:US
Mailing Address - Phone:903-758-9090
Mailing Address - Fax:903-758-1701
Practice Address - Street 1:2304 JUDSON RD
Practice Address - Street 2:STE B
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4673
Practice Address - Country:US
Practice Address - Phone:903-758-9090
Practice Address - Fax:903-758-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3645TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0195786-01Medicaid
TX0990200001Medicare NSC
TX0A3845Medicare PIN
TXT14098Medicare UPIN