Provider Demographics
NPI:1093945354
Name:JONES, SUZANNE MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MARIE
Last Name:JONES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:SUZANNE
Other - Middle Name:MARIE
Other - Last Name:MCCATTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6909 N LOOP 1604 E
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-5317
Mailing Address - Country:US
Mailing Address - Phone:210-651-0985
Mailing Address - Fax:210-858-6664
Practice Address - Street 1:6909 N LOOP 1604 E
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-5317
Practice Address - Country:US
Practice Address - Phone:210-651-0985
Practice Address - Fax:210-858-6664
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7055T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286132003Medicaid