Provider Demographics
NPI:1962496430
Name:JONES, MEGAN NOEL (OD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:NOEL
Last Name:JONES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:NOEL
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:120 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-1027
Mailing Address - Country:US
Mailing Address - Phone:765-778-7524
Mailing Address - Fax:765-778-7525
Practice Address - Street 1:120 E STATE ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-1027
Practice Address - Country:US
Practice Address - Phone:765-778-7524
Practice Address - Fax:765-778-7525
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003294A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000350074OtherBLUE CROSS AND BLUE SHIELD OF INDIANA
201417380OtherVISION SERVICE PLAN
IN219820AMedicare PIN
IN000000350074OtherBLUE CROSS AND BLUE SHIELD OF INDIANA
201417380OtherVISION SERVICE PLAN