Provider Demographics
NPI:1508948258
Name:PONDER, JANA HARRELL (OD)
Entity Type:Individual
Prefix:DR
First Name:JANA
Middle Name:HARRELL
Last Name:PONDER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8461
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75671-8461
Mailing Address - Country:US
Mailing Address - Phone:903-927-2861
Mailing Address - Fax:903-927-2862
Practice Address - Street 1:1701 E END BLVD N
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-0713
Practice Address - Country:US
Practice Address - Phone:903-927-2861
Practice Address - Fax:903-927-2862
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4872TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist