Provider Demographics
NPI:1265423057
Name:RICHARD D JONES ODPC
Entity type:Organization
Organization Name:RICHARD D JONES ODPC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:307-548-7450
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:LOVELL
Mailing Address - State:WY
Mailing Address - Zip Code:82431-0785
Mailing Address - Country:US
Mailing Address - Phone:307-548-7450
Mailing Address - Fax:307-548-7596
Practice Address - Street 1:426 NEVADA AVE
Practice Address - Street 2:
Practice Address - City:LOVELL
Practice Address - State:WY
Practice Address - Zip Code:82431-1916
Practice Address - Country:US
Practice Address - Phone:307-548-7450
Practice Address - Fax:307-548-7596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY140T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
306557OtherBCBS
P66963Medicare UPIN
WY306557Medicare ID - Type Unspecified