Provider Demographics
NPI:1659591626
Name:JONES, ALAN MARTIN (OD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:MARTIN
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 1:4851 WEST HILLSBORO BLVD
Mailing Address - Street 2:A-6
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073
Mailing Address - Country:US
Mailing Address - Phone:954-427-1449
Mailing Address - Fax:954-427-1458
Practice Address - Street 1:4851 WEST HILLSBORO BLVD
Practice Address - Street 2:A-6
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073
Practice Address - Country:US
Practice Address - Phone:954-427-1449
Practice Address - Fax:954-427-1458
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1843152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078544000Medicaid
FL0506840001Medicare NSC
FL078544000Medicaid