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General NPI Number Information
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NPI Number | 1801071675
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Entity Type | Organization
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Legal Business Name | CHARLES LOWELL JONES JR OD
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Dates
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Enumeration Date | 12/29/2007
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Last Update Date | 02/26/2008
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Provider Practice Location Address
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Address Line | 224 VIRGINIA ST
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City | INDIANOLA
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State | MS
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Zip | 38751-2221
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Country | US
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Telephone | 662-887-3671
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Fax | 662-887-3675
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Provider Business Mailing Address
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Address Line | 224 VIRGINIA ST
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City | INDIANOLA
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State | MS
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Zip | 38751-2221
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Country | US
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Telephone | 662-887-3671
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Fax | 662-887-3675
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. CHARLES L JONES JR.
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Credential | OD
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Telephone | 662-887-3671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 444
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License Number State | MS
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