Provider Demographics
NPI:1700061173
Name:JONES OAKLAND VISION GROUP P A
Entity Type:Organization
Organization Name:JONES OAKLAND VISION GROUP P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:V
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-334-1016
Mailing Address - Street 1:888 MEMORIAL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-5112
Mailing Address - Country:US
Mailing Address - Phone:301-334-1016
Mailing Address - Fax:301-334-9729
Practice Address - Street 1:888 MEMORIAL DR STE 101
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-5112
Practice Address - Country:US
Practice Address - Phone:301-334-1016
Practice Address - Fax:301-334-9729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00794152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD239019OtherOPTIMUM CHOICE
MDDT3340OtherPALMETTO RR MEDICARE PTAN
MDN9320001OtherBCBS PROVIDER #
WV3810023841Medicaid
MD214828500Medicaid
MDT59948Medicare UPIN
MD243746Medicare PIN
MD0288850001Medicare NSC