Healthcare Provider Details

I. General information

NPI: 1265423057
Provider Name (Legal Business Name): RICHARD D JONES ODPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 NEVADA AVE
LOVELL WY
82431-1916
US

IV. Provider business mailing address

PO BOX 785
LOVELL WY
82431-0785
US

V. Phone/Fax

Practice location:
  • Phone: 307-548-7450
  • Fax: 307-548-7596
Mailing address:
  • Phone: 307-548-7450
  • Fax: 307-548-7596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number140T
License Number StateWY

VIII. Authorized Official

Name: MR. RICHARD D JONES
Title or Position: OWNER PRESIDENT
Credential: OD
Phone: 307-548-7450