Provider Demographics
NPI:1174612394
Name:JONES, DUSTIN J (OD)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:J
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 1:1301 MAIN ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467-4451
Mailing Address - Country:US
Mailing Address - Phone:208-756-2020
Mailing Address - Fax:208-756-3741
Practice Address - Street 1:1301 MAIN ST
Practice Address - Street 2:SUITE 10
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467-4451
Practice Address - Country:US
Practice Address - Phone:208-756-2020
Practice Address - Fax:208-756-3741
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5156353-9934152W00000X
IDODP-100011152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist