Provider Demographics
NPI:1467446211
Name:JONES, JERRY RAYMOND (OD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:RAYMOND
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 23896
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98093-0896
Mailing Address - Country:US
Mailing Address - Phone:253-841-1575
Mailing Address - Fax:253-840-5543
Practice Address - Street 1:13909 MERIDIAN E
Practice Address - Street 2:A4
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-9180
Practice Address - Country:US
Practice Address - Phone:253-841-1575
Practice Address - Fax:253-840-5543
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1004TX152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2050102Medicaid
WATO2044Medicare UPIN
WA001001820Medicare PIN