Provider Demographics
NPI:1275545659
Name:JONES, THOMAS E (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
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 1:940 W MOUNT VERNON ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-9609
Mailing Address - Country:US
Mailing Address - Phone:417-724-5335
Mailing Address - Fax:417-724-5333
Practice Address - Street 1:940 W MOUNT VERNON ST
Practice Address - Street 2:SUITE 120
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-9609
Practice Address - Country:US
Practice Address - Phone:417-724-5335
Practice Address - Fax:417-724-5333
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02977152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO316675719Medicaid
P00653956OtherRR MCR
MO914203230Medicare PIN
MO316675719Medicaid
MO914203888Medicare ID - Type UnspecifiedPART B MEDICARE NUMBER