Provider Demographics
NPI:1174660252
Name:JONES, WAYNE DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:DAVID
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 1:13646 QUARTS CANYON LANE
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-6530
Mailing Address - Country:US
Mailing Address - Phone:605-341-2200
Mailing Address - Fax:
Practice Address - Street 1:925 EGLIN ST.
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-9567
Practice Address - Country:US
Practice Address - Phone:605-341-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD524152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist