Provider Demographics
NPI:1578727368
Name:JONES, MATTHEW ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ROBERT
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 1:118 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2354
Mailing Address - Country:US
Mailing Address - Phone:217-342-2672
Mailing Address - Fax:217-342-2681
Practice Address - Street 1:118 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2354
Practice Address - Country:US
Practice Address - Phone:217-342-2672
Practice Address - Fax:217-342-2681
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010064152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist