Provider Demographics
NPI:1881627628
Name:JONES, ELLIS R (OD)
Entity type:Individual
Prefix:DR
First Name:ELLIS
Middle Name:R
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 1:6300 OAKMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-2807
Mailing Address - Country:US
Mailing Address - Phone:817-294-2010
Mailing Address - Fax:817-738-7724
Practice Address - Street 1:6300 OAKMONT BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-2807
Practice Address - Country:US
Practice Address - Phone:817-294-2010
Practice Address - Fax:817-738-7724
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04102152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U87652Medicare UPIN
8F4745Medicare PIN