Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 1903 | SC |
Y | 152W00000X | Optometrist | OPT.006551 | OH |
N | 152W00000X | Optometrist | OPT002911 | GA |
NPI | 1003104365 |
---|---|
Provider Name | Sandra K Jones |
First Address | Alton, IL 62002-6220 |
Second Address | Mentor, OH 44060-7522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2011 |
Last Update Date | 12/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D19036 | (05) | SC |