Provider Demographics
NPI:1164590030
Name:JONES, EDWARD LAWRENCE (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LAWRENCE
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 1:601 W GOWE ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-5745
Mailing Address - Country:US
Mailing Address - Phone:253-854-2028
Mailing Address - Fax:253-854-2744
Practice Address - Street 1:601 W GOWE ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5745
Practice Address - Country:US
Practice Address - Phone:253-854-2028
Practice Address - Fax:253-854-2744
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00001651152W00000X
WAHA 00000679237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2030187Medicaid
WAG8880385OtherMEDICARE PTAN
WAG8880385OtherMEDICARE PTAN
WA2030187Medicaid