Healthcare Provider Details

I. General information

NPI: 1891763207
Provider Name (Legal Business Name): DURWARD JONES THOMAS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 RINGGOLD AVE
COUSHATTA LA
71019-9089
US

IV. Provider business mailing address

1902 RINGGOLD AVE P.O. BOX 323
COUSHATTA LA
71019-9089
US

V. Phone/Fax

Practice location:
  • Phone: 318-932-5671
  • Fax: 318-932-5671
Mailing address:
  • Phone: 318-932-5671
  • Fax: 318-932-5671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number873063T
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: