Provider Demographics
NPI:1255426912
Name:JONES, CODY E (OD)
Entity type:Individual
Prefix:MR
First Name:CODY
Middle Name:E
Last Name:JONES
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 1:720 N MERIDIAN ST
Mailing Address - Street 2:STE A
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-4936
Mailing Address - Country:US
Mailing Address - Phone:208-242-7900
Mailing Address - Fax:
Practice Address - Street 1:34 SE MAIN ST
Practice Address - Street 2:STE 101
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-5094
Practice Address - Country:US
Practice Address - Phone:208-785-7274
Practice Address - Fax:208-785-7337
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13076 T152W00000X
IDODP-100178152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist