Provider Demographics
NPI:1922093517
Name:JONES, TASHA J (OD)
Entity Type:Individual
Prefix:DR
First Name:TASHA
Middle Name:J
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 1:1208 22ND AVE S
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2804
Mailing Address - Country:US
Mailing Address - Phone:605-692-2020
Mailing Address - Fax:605-692-9594
Practice Address - Street 1:1208 22ND AVE S
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2804
Practice Address - Country:US
Practice Address - Phone:605-692-2020
Practice Address - Fax:605-692-9594
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD603152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD39563OtherSIOUX VALLEY HEALTH
SD4995289OtherBCBS OF SD
SD9203392Medicaid
SD603OtherDAKOTA CARE
SDP00815932OtherRAILROAD MEDICARE
SD4995289OtherBCBS OF SD
SD9203392Medicaid