Provider Demographics
NPI:1457764847
Name:JONES, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 N NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3342
Mailing Address - Country:US
Mailing Address - Phone:847-292-1689
Mailing Address - Fax:
Practice Address - Street 1:140 N NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3342
Practice Address - Country:US
Practice Address - Phone:847-292-1689
Practice Address - Fax:847-292-1802
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010781152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist