Provider Demographics
NPI:1356399976
Name:JONES, JEFFREY WILLIAM (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WILLIAM
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 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:2304 JUDSON RD
Practice Address - Street 2:SUITE B
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4673
Practice Address - Country:US
Practice Address - Phone:903-758-9090
Practice Address - Fax:903-758-1701
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03645TG152WC0802X
TX3645152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019578601Medicaid
TX019578601Medicaid
TX0990200001Medicare NSC
TX0A3845Medicare PIN