Provider Demographics
NPI:1770626947
Name:JONES, CARLA LESLIE (OD)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:LESLIE
Last Name:JONES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4975 HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:TENNESSEE RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37178-6033
Mailing Address - Country:US
Mailing Address - Phone:931-827-9137
Mailing Address - Fax:
Practice Address - Street 1:1680 FORT CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-3537
Practice Address - Country:US
Practice Address - Phone:931-645-5851
Practice Address - Fax:931-645-6917
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1681152W00000X
KY1656152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist