Provider Demographics
NPI:1740438662
Name:JONES, MARCUS
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:IDEAL
Other - Middle Name:
Other - Last Name:OPTICAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IDEAL OPTICAL
Mailing Address - Street 1:5811 BERKMAN DR
Mailing Address - Street 2:121
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-2666
Mailing Address - Country:US
Mailing Address - Phone:512-926-2400
Mailing Address - Fax:512-926-2608
Practice Address - Street 1:5811 BERKMAN DR
Practice Address - Street 2:121
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-2666
Practice Address - Country:US
Practice Address - Phone:512-926-2400
Practice Address - Fax:512-926-2608
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX263146320156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician