Provider Demographics
NPI:1720464878
Name:JONES, TRAVIS (OD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
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 1:17792 538TH ST
Mailing Address - Street 2:
Mailing Address - City:GRISWOLD
Mailing Address - State:IA
Mailing Address - Zip Code:51535-4290
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3201 MANAWA CENTRE DR
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-7672
Practice Address - Country:US
Practice Address - Phone:712-366-5101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1800-734AT152W00000X
IA111912152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist