MEDICARE: KIRK W JONES LDO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	1017	GA

General Provider Information

NPI Number	:	1376555409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRK W JONES LDO

Provider Business Mailing Address
First Line	:	1010 PRINCE AVE
Second Line	:	SUITE 110
City	:	ATHENS
State	:	GA
Zip	:	30606-5805
Country	:	US
Telephone Number	:	706-549-9993
Fax Number	:	706-549-4047

Provider Business Practice Location Address
First Line	:	1010 PRINCE AVE
Second Line	:	SUITE 110
City	:	ATHENS
State	:	GA
Zip	:	30606-5805
Country	:	US
Telephone Number	:	706-549-9993
Fax Number	:	706-549-4047

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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