Provider Demographics
NPI:1891809406
Name:JONES, BRENT W (OD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:W
Last Name:JONES
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:472 W POPLAR AVE STE 102
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2595
Practice Address - Country:US
Practice Address - Phone:901-329-8055
Practice Address - Fax:901-234-0133
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2020-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN2372152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN35900062Medicare PIN