Provider Demographics
NPI:1295730406
Name:JONES, RICHARD DAVID (OD, FAAO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:DAVID
Last Name:JONES
Suffix:
Gender:M
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 FOURTH STREET
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4505
Mailing Address - Country:US
Mailing Address - Phone:707-542-1554
Mailing Address - Fax:707-542-1252
Practice Address - Street 1:800 FOURTH STREET
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4505
Practice Address - Country:US
Practice Address - Phone:707-542-1554
Practice Address - Fax:707-542-1252
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5543T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0055430Medicaid
CAT10027Medicare UPIN
CA4789750001Medicare NSC