Provider Demographics
NPI:1477817625
Name:JONES, BLAKELY KYLE (OD)
Entity Type:Individual
Prefix:DR
First Name:BLAKELY
Middle Name:KYLE
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 1:6694 PICKENS BRIDGE RD
Mailing Address - Street 2:UNIT 17
Mailing Address - City:PINEY FLATS
Mailing Address - State:TN
Mailing Address - Zip Code:37686-4165
Mailing Address - Country:US
Mailing Address - Phone:334-207-7730
Mailing Address - Fax:
Practice Address - Street 1:1008 INDIAN TRAIL DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4623
Practice Address - Country:US
Practice Address - Phone:423-247-2020
Practice Address - Fax:423-246-2396
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3047152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist