Provider Demographics
NPI:1528030095
Name:JONES, WAYNE ERIC (OD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:ERIC
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 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:1327 TROUP HWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4443
Practice Address - Country:US
Practice Address - Phone:903-606-4733
Practice Address - Fax:903-606-5853
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008905152W00000X
TX9135152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046008905 1Medicaid
IL046008905 1Medicaid
IL4669520002Medicare NSC
IL4669520004Medicare NSC
ILP00333357Medicare PIN
IL4669520001Medicare NSC
IL203195Medicare PIN
ILK07867Medicare UPIN
IL4669520003Medicare NSC
IL203194Medicare PIN
ILCK5585Medicare PIN