Provider Demographics
NPI:1376771808
Name:R. DAVID JONES, O.D.
Entity Type:Organization
Organization Name:R. DAVID JONES, O.D.
Other - Org Name:EMPIRE OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:B
Authorized Official - Last Name:BERNHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-542-1554
Mailing Address - Street 1:800 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4505
Mailing Address - Country:US
Mailing Address - Phone:707-542-1554
Mailing Address - Fax:707-542-1252
Practice Address - Street 1:800 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4505
Practice Address - Country:US
Practice Address - Phone:707-542-1554
Practice Address - Fax:707-542-1252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5543T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0055430OtherPTAN
CASD0055430Medicaid
CASD0055430OtherPTAN
CASD0055430Medicaid