1720004153 NPI number — JONES VISION CENTER

Table of content: (NPI 1720004153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720004153 NPI number — JONES VISION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JONES VISION CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720004153
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1515 LAKE LANSING RD
Provider Second Line Business Mailing Address:
SUITE G
Provider Business Mailing Address City Name:
LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48912-3753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-332-2233
Provider Business Mailing Address Fax Number:
517-332-8035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 LAKE LANSING RD
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48912-3753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-332-2233
Provider Business Practice Location Address Fax Number:
517-332-8035
Provider Enumeration Date:
07/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
RAMONA
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
517-332-2233

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4901003667 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 4901003668 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 22-00082 . This is a "DR. RAMONA H. JONES PHPMM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 22-00059 . This is a "DR. ROBERT A. JONES PHPMM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 22-70082 . This is a "DR. RAMONA H. JONES PHPFC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 22-70059 . This is a "DR. ROBERT A. JONES PHPFC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 900C377040 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 94-4414365 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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