Provider Demographics
NPI:1891763207
Name:THOMAS, DURWARD JONES (OD)
Entity Type:Individual
Prefix:DR
First Name:DURWARD
Middle Name:JONES
Last Name:THOMAS
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 1:1902 RINGGOLD AVE
Mailing Address - Street 2:P.O. BOX 323
Mailing Address - City:COUSHATTA
Mailing Address - State:LA
Mailing Address - Zip Code:71019-9089
Mailing Address - Country:US
Mailing Address - Phone:318-932-5671
Mailing Address - Fax:318-932-5671
Practice Address - Street 1:1902 RINGGOLD AVE
Practice Address - Street 2:
Practice Address - City:COUSHATTA
Practice Address - State:LA
Practice Address - Zip Code:71019-9089
Practice Address - Country:US
Practice Address - Phone:318-932-5671
Practice Address - Fax:318-932-5671
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA873063T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAT19482Medicare UPIN
LA1891763207Medicare NSC
LA47949Medicare PIN