Healthcare Provider Details

I. General information

NPI: 1811941255
Provider Name (Legal Business Name): KIRAN B JONES OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 MOOSEHEAD TRL
NEWPORT ME
04953-4054
US

IV. Provider business mailing address

419 MOOSEHEAD TRL
NEWPORT ME
04953-4001
US

V. Phone/Fax

Practice location:
  • Phone: 207-355-3333
  • Fax: 207-368-2002
Mailing address:
  • Phone: 207-355-3333
  • Fax: 207-368-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT872
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT872
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier048925
Identifier TypeOTHER
Identifier StateME
Identifier IssuerSTAR ID
# 2
Identifier431998600
Identifier TypeMEDICAID
Identifier StateME
Identifier Issuer
# 3
Identifier431998601
Identifier TypeMEDICAID
Identifier StateME
Identifier Issuer
# 4
Identifier7339571
Identifier TypeOTHER
Identifier StateME
Identifier IssuerAETNA PPO
# 5
Identifier1090025
Identifier TypeOTHER
Identifier StateME
Identifier IssuerAETNA
# 6
Identifier408610099
Identifier TypeMEDICAID
Identifier StateME
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: