1770661183 NPI number — DR. AVERY THOMAS JONES OD

Table of content: (NPI 1336800721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770661183 NPI number — DR. AVERY THOMAS JONES OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
AVERY
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

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:
1770661183
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 SO WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND FORKS
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-775-3135
Provider Business Mailing Address Fax Number:
701-772-8161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 SO WASHINGTON ST
Provider Second Line Business Practice Location Address:
VALLEY VISION CLINIC
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-775-3135
Provider Business Practice Location Address Fax Number:
701-772-8161
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2757 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 412 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 60081 . This is a "ND DEPT OF HUMAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 410001573 . This is a "MEDICARE RAILROAD UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60327 . This is a "VOCATIONAL REHAB CENTER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60327 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: JON8828 . This is a "BLUE SHIELD OF ND VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 85536JO . This is a "BCBS MN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 85536JO . This is a "MN COMPREHENSIVE CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: JON800412 . This is a "VISION SERVICES INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: JON8828 . This is a "BLUE SHIELD OF ND ALTRU" identifier . This identifiers is of the category "OTHER".
  • Identifier: 140691 . This is a "U CARE MN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2201969 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 670825100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 85536JO . This is a "BLUE PLUS OF MN" identifier . This identifiers is of the category "OTHER".
  • Identifier: JON8828 . This is a "BCBS ND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 670825100 . This is a "MN DEPT OF HUMAN" identifier . This identifiers is of the category "OTHER".




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