Provider Demographics
NPI:1770109282
Name:JONES, NATHAN (OD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
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:PO BOX 3187
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-3187
Mailing Address - Country:US
Mailing Address - Phone:208-351-9190
Mailing Address - Fax:
Practice Address - Street 1:2300 E 17TH ST SPC 157
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6501
Practice Address - Country:US
Practice Address - Phone:208-552-3355
Practice Address - Fax:208-552-6120
Is Sole Proprietor?:No
Enumeration Date:2020-06-20
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002440152W00000X
IDODP-100565152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist