1962496430 NPI number — DR. MEGAN NOEL JONES OD

Table of content: DR. MEGAN NOEL JONES OD (NPI 1962496430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962496430 NPI number — DR. MEGAN NOEL JONES OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
MEGAN
Provider Middle Name:
NOEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JACKSON
Provider Other First Name:
MEGAN
Provider Other Middle Name:
NOEL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962496430
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 E STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENDLETON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46064-1027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-778-7524
Provider Business Mailing Address Fax Number:
765-778-7525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 E STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENDLETON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46064-1027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-778-7524
Provider Business Practice Location Address Fax Number:
765-778-7525
Provider Enumeration Date:
09/09/2005

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:  18003294A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000350074 . This is a "BLUE CROSS AND BLUE SHIELD OF INDIANA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 201417380 . This is a "VISION SERVICE PLAN" identifier . This identifiers is of the category "OTHER".




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