Provider Demographics
NPI:1912107608
Name:JONES, JEFFREY A (OD LLC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:JONES
Suffix:
Gender:M
Credentials:OD LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 NE HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701
Mailing Address - Country:US
Mailing Address - Phone:541-693-9714
Mailing Address - Fax:
Practice Address - Street 1:2500 NE HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6277
Practice Address - Country:US
Practice Address - Phone:541-693-9714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2333T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000PHGYMMedicare PIN