Provider Demographics
NPI:1144384835
Name:DOOLEY, JON STEVEN (OD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:STEVEN
Last Name:DOOLEY
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 1:1204 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240-1251
Mailing Address - Country:US
Mailing Address - Phone:812-663-7015
Mailing Address - Fax:812-663-7136
Practice Address - Street 1:1204 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-1251
Practice Address - Country:US
Practice Address - Phone:812-663-7015
Practice Address - Fax:812-663-7136
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2010-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001913B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0481850001OtherDMERC
IN100098540Medicaid
IN181170AMedicare PIN
IN0481850001OtherDMERC