Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OP 2281 | FL |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OP 2281 | FL |
NPI | 1003831165 |
---|---|
Provider Name | Dr. Mark S Jones |
First Address | Panama City, FL 32405-4412 |
Second Address | Panama City, FL 32405-4412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 09/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
084167600 | (05) | FL |
19054 | BLUE CROSS & BLUE SHIELD (01) | FL |
410042389 | RR MEDICARE (01) | FL |
UO6387 | (02) | FL |