Provider Demographics
NPI:1295812865
Name:JONES, KAREN ELIZABETH (OD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ELIZABETH
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 1:6714 FORTESCUE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-2102
Mailing Address - Country:US
Mailing Address - Phone:704-509-0328
Mailing Address - Fax:
Practice Address - Street 1:10210 PROSPERITY PARK DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-1103
Practice Address - Country:US
Practice Address - Phone:704-875-8787
Practice Address - Fax:704-875-7171
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1797152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89093JWMedicaid
NE093JWOtherBCBS
NCNC1797OtherEYEMED PROVIDER NUMBER
NC2471912BMedicare PIN
NE093JWOtherBCBS