Provider Demographics
NPI:1235200429
Name:JONES, TOD W (OD)
Entity Type:Individual
Prefix:DR
First Name:TOD
Middle Name:W
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 1:1616 N 18TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2600
Mailing Address - Country:US
Mailing Address - Phone:360-424-4181
Mailing Address - Fax:360-424-6414
Practice Address - Street 1:1616 N 18TH ST STE 104
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2600
Practice Address - Country:US
Practice Address - Phone:360-424-4181
Practice Address - Fax:360-424-6414
Is Sole Proprietor?:No
Enumeration Date:2006-11-11
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003502152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA410044967OtherRR MEDICARE
WA2023091Medicaid
WA3945970001Medicare NSC
WAGAB17339Medicare PIN
WAU77387Medicare UPIN