Provider Demographics
NPI:1215577507
Name:JONES, DENISE R (LDO)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:R
Last Name:JONES
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6115 METROPOLITAN AVE # STORE549
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-2644
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6115 METROPOLITAN AVE # STORE549
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-2644
Practice Address - Country:US
Practice Address - Phone:718-312-6959
Practice Address - Fax:718-497-1055
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009819156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician