Healthcare Provider Details

I. General information

NPI: 1700061173
Provider Name (Legal Business Name): JONES OAKLAND VISION GROUP P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 MEMORIAL DR STE 101
OAKLAND MD
21550-5112
US

IV. Provider business mailing address

888 MEMORIAL DR STE 101
OAKLAND MD
21550-5112
US

V. Phone/Fax

Practice location:
  • Phone: 301-334-1016
  • Fax: 301-334-9729
Mailing address:
  • Phone: 301-334-1016
  • Fax: 301-334-9729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number00794
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number00794
License Number StateMD

VIII. Authorized Official

Name: JAMES V JONES
Title or Position: PRESIDENT
Credential: OD
Phone: 301-334-1016