Provider Demographics
NPI:1477564714
Name:JONES, JEFFERY ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:ALAN
Last Name:JONES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:A
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1301 SUBELLA DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-0835
Mailing Address - Country:US
Mailing Address - Phone:573-424-0343
Mailing Address - Fax:
Practice Address - Street 1:2901 WEST BROADWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-0669
Practice Address - Country:US
Practice Address - Phone:573-447-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMOT03025152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA3041001Medicare UPIN