Provider Demographics
NPI:1700867884
Name:RICHARD D JONES ODPC
Entity Type:Organization
Organization Name:RICHARD D JONES ODPC
Other - Org Name:FAMILY VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:307-587-2404
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-1300
Mailing Address - Country:US
Mailing Address - Phone:307-587-2404
Mailing Address - Fax:307-527-7368
Practice Address - Street 1:1708 STAMPEDE AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4829
Practice Address - Country:US
Practice Address - Phone:307-587-2404
Practice Address - Fax:307-527-7368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY140T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY013959800Medicaid
0738340002OtherDEMERC
305326OtherBCBS
759870709OtherRAIROAD MEDICARE
759870709OtherRAIROAD MEDICARE
WY013959800Medicaid
759870709OtherRAIROAD MEDICARE