Healthcare Provider Details
I. General information
NPI: 1093945354
Provider Name (Legal Business Name): SUZANNE MARIE JONES O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 07/21/2009
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:
III. Provider practice location address
6909 N LOOP 1604 E
SAN ANTONIO TX
78247-5317
US
IV. Provider business mailing address
6909 N LOOP 1604 E
SAN ANTONIO TX
78247-5317
US
V. Phone/Fax
- Phone: 210-651-0985
- Fax: 210-858-6664
- Phone: 210-651-0985
- Fax: 210-858-6664
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 152W00000X |
| Taxonomy | Optometrist |
| License Number | 7055T |
| License Number State | TX |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: