Provider Demographics
NPI:1821404633
Name:JONES, KRISTAL (OD)
Entity Type:Individual
Prefix:
First Name:KRISTAL
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MAIN ST E
Mailing Address - Street 2:PO BOX 261
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-2440
Mailing Address - Country:US
Mailing Address - Phone:952-758-2080
Mailing Address - Fax:952-758-5922
Practice Address - Street 1:1101 1ST ST NE
Practice Address - Street 2:
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071-2197
Practice Address - Country:US
Practice Address - Phone:952-758-2080
Practice Address - Fax:952-758-5922
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3396152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1821404633Medicaid