Provider Demographics
NPI:1447249859
Name:JONES, GREGORY L (OD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:L
Last Name:JONES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-2750
Mailing Address - Country:US
Mailing Address - Phone:716-664-7601
Mailing Address - Fax:
Practice Address - Street 1:555 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-2750
Practice Address - Country:US
Practice Address - Phone:716-664-7601
Practice Address - Fax:716-664-3353
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003267-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5468728OtherAETNA US HEALTHCARE
NY00040168901OtherUNIVERA HEALTHCARE
NY30926DMedicare ID - Type UnspecifiedUPSTATE MEDICARE
NY5468728OtherAETNA US HEALTHCARE