Provider Demographics
NPI:1083607949
Name:JONES, MICHAEL J (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
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 1:15786 SPRINGDALE ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-1316
Mailing Address - Country:US
Mailing Address - Phone:714-892-2987
Mailing Address - Fax:801-996-5178
Practice Address - Street 1:15786 SPRINGDALE ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-1316
Practice Address - Country:US
Practice Address - Phone:714-892-2987
Practice Address - Fax:801-996-5178
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAOPT8751T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5431422Medicaid
CA5431422Medicaid
CA025423001Medicare ID - Type Unspecified