Provider Demographics
NPI:1811941255
Name:JONES, KIRAN B (OD)
Entity type:Individual
Prefix:
First Name:KIRAN
Middle Name:B
Last Name:JONES
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 MOOSEHEAD TRL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04953-4001
Mailing Address - Country:US
Mailing Address - Phone:207-355-3333
Mailing Address - Fax:207-368-2002
Practice Address - Street 1:419 MOOSEHEAD TRL
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:ME
Practice Address - Zip Code:04953-4054
Practice Address - Country:US
Practice Address - Phone:207-355-3333
Practice Address - Fax:207-368-2002
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT872152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME048925OtherSTAR ID
ME431998600Medicaid
ME431998601Medicaid
ME7339571OtherAETNA PPO
ME1090025OtherAETNA
ME408610099Medicaid
ME431998601Medicaid
ME1090025OtherAETNA