Provider Demographics
NPI:1972553923
Name:JONES, ANDREW W (OD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:W
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 1:4236 S DARRELL DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-9088
Mailing Address - Country:US
Mailing Address - Phone:812-847-7880
Mailing Address - Fax:812-847-8104
Practice Address - Street 1:2251 E STATE HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-9498
Practice Address - Country:US
Practice Address - Phone:812-847-7880
Practice Address - Fax:812-847-8104
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002602B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU34901Medicare UPIN
IN130780Medicare ID - Type Unspecified