Provider Demographics
NPI:1578634689
Name:ANDREW W. JONES OD PC
Entity Type:Organization
Organization Name:ANDREW W. JONES OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:W
Authorized Official - Last Name:JONES
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:812-847-7880
Mailing Address - Street 1:4236 S DARRELL DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-9088
Mailing Address - Country:US
Mailing Address - Phone:812-825-2020
Mailing Address - Fax:812-847-8104
Practice Address - Street 1:2251 E STATE HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-9498
Practice Address - Country:US
Practice Address - Phone:812-847-7880
Practice Address - Fax:812-847-8104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-11
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN130780Medicare PIN
INU34901Medicare UPIN