Provider Demographics
NPI:1780723593
Name:JONES, MARK JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAMES
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 1:107 E AIRPORT HWY
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:OH
Mailing Address - Zip Code:43558
Mailing Address - Country:US
Mailing Address - Phone:419-826-3937
Mailing Address - Fax:
Practice Address - Street 1:107 E AIRPORT HWY
Practice Address - Street 2:
Practice Address - City:SWANTON
Practice Address - State:OH
Practice Address - Zip Code:43558
Practice Address - Country:US
Practice Address - Phone:419-826-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4203 T501152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U12584Medicare UPIN
J00680392Medicare ID - Type Unspecified