Provider Demographics
NPI:1316023583
Name:JONES, WILLIAM LOUIS (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LOUIS
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 1:5600 WYOMING NE
Mailing Address - Street 2:STE 210
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3149
Mailing Address - Country:US
Mailing Address - Phone:550-582-8082
Mailing Address - Fax:505-828-0848
Practice Address - Street 1:5600 WYOMING NE
Practice Address - Street 2:STE 210
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3149
Practice Address - Country:US
Practice Address - Phone:505-828-0828
Practice Address - Fax:505-828-0848
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM275152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM21433348Medicaid
NM349600304Medicare PIN