Provider Demographics
NPI:1003831165
Name:JONES, MARK S (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
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 1:2500 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4412
Mailing Address - Country:US
Mailing Address - Phone:850-784-3937
Mailing Address - Fax:850-522-9829
Practice Address - Street 1:2500 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4412
Practice Address - Country:US
Practice Address - Phone:850-784-3937
Practice Address - Fax:850-522-9829
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP 2281152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084167600Medicaid
FL410042389OtherRR MEDICARE
FL19054OtherBLUE CROSS & BLUE SHIELD
FL410042389OtherRR MEDICARE
FL19054OtherBLUE CROSS & BLUE SHIELD