Provider Demographics
NPI:1417977844
Name:JONES, DAVID C (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
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:PO BOX 1128
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73802-1128
Mailing Address - Country:US
Mailing Address - Phone:580-256-7755
Mailing Address - Fax:580-256-4819
Practice Address - Street 1:1709 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-2938
Practice Address - Country:US
Practice Address - Phone:580-256-7755
Practice Address - Fax:580-256-4819
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2365152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200003980BMedicaid
U92398Medicare UPIN
OK200003980BMedicaid
OK0463070001Medicare NSC
241328408Medicare ID - Type Unspecified