Provider Demographics
NPI:1023279908
Name:JONES, MICHELLE DAWN (OD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:DAWN
Last Name:JONES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:DAWN
Other - Last Name:VAN VARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:518 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1636
Mailing Address - Country:US
Mailing Address - Phone:641-230-7015
Mailing Address - Fax:
Practice Address - Street 1:518 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1636
Practice Address - Country:US
Practice Address - Phone:641-230-7015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002430152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist