Provider Demographics
NPI:1326300666
Name:JONES, KRISTINE MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:MARIE
Last Name:JONES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30866 FIELD STONE DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9381
Mailing Address - Country:US
Mailing Address - Phone:812-272-5718
Mailing Address - Fax:
Practice Address - Street 1:700 W IRELAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614
Practice Address - Country:US
Practice Address - Phone:574-299-1471
Practice Address - Fax:574-299-1477
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003732A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300003823Medicaid
IN300005932Medicaid