Provider Demographics
NPI:1396841888
Name:JONES, GRANT WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:WILLIAM
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 1:1418 E M ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-3533
Mailing Address - Country:US
Mailing Address - Phone:307-532-4114
Mailing Address - Fax:307-532-7658
Practice Address - Street 1:1418 E M ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-3533
Practice Address - Country:US
Practice Address - Phone:307-532-4114
Practice Address - Fax:307-532-7658
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY247T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY11293100Medicaid
WYU66141Medicare UPIN
WY11293100Medicaid