Provider Demographics
NPI:1558369009
Name:JONES, ROGER IGNATIUS (OD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:IGNATIUS
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 1:411 PARK PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-5449
Mailing Address - Country:US
Mailing Address - Phone:270-686-1937
Mailing Address - Fax:270-686-0000
Practice Address - Street 1:411 PARK PLAZA DR
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-5449
Practice Address - Country:US
Practice Address - Phone:270-686-1937
Practice Address - Fax:270-686-0000
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY953DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77009538Medicaid
KYT54703Medicare UPIN
KY4942610001Medicare NSC
KY9211001Medicare PIN