Provider Demographics
NPI:1639278732
Name:JONS, CHRISTOPHER LEROY (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LEROY
Last Name:JONS
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 1:114 W ANGUS ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-1830
Mailing Address - Country:US
Mailing Address - Phone:307-684-5501
Mailing Address - Fax:307-684-5503
Practice Address - Street 1:114 W ANGUS ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-1830
Practice Address - Country:US
Practice Address - Phone:307-684-5501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY305T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY21673Medicare PIN
WYV10464Medicare UPIN
WY20942Medicare PIN
WY5910820001Medicare NSC