Provider Demographics
NPI:1467448845
Name:JONES JR, WILLIAM HAROLD (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HAROLD
Last Name:JONES JR
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 1:117 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IN
Mailing Address - Zip Code:47882-1804
Mailing Address - Country:US
Mailing Address - Phone:812-268-4700
Mailing Address - Fax:812-268-4701
Practice Address - Street 1:117 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IN
Practice Address - Zip Code:47882-1804
Practice Address - Country:US
Practice Address - Phone:812-268-4700
Practice Address - Fax:812-268-4701
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003075A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200440140Medicaid
IN199960Medicare ID - Type Unspecified
IN4712730001Medicare NSC