Provider Demographics
NPI:1033857602
Name:JONES, ETHAN CHANDLER (OD)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:CHANDLER
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 1:124 HUNTERS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-5390
Mailing Address - Country:US
Mailing Address - Phone:931-581-9055
Mailing Address - Fax:
Practice Address - Street 1:2100 HAMILTON PLACE BLVD STE 147
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6055
Practice Address - Country:US
Practice Address - Phone:423-899-8626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OPTOMETRY390200000X
TN3753152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program