MEDICARE: R. DAVID JONES, O.D.

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	152W00000X	Optometrist	5543T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SD0055430	OTHER	CA	PTAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376771808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R. DAVID JONES, O.D.

Provider Business Mailing Address
First Line	:	800 4TH ST
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-4505
Country	:	US
Telephone Number	:	707-542-1554
Fax Number	:	707-542-1252

Provider Business Practice Location Address
First Line	:	800 4TH ST
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-4505
Country	:	US
Telephone Number	:	707-542-1554
Fax Number	:	707-542-1252

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CHERYL B BERNHARDT
Credential	:
Telephone Number	:	707-542-1554

Provider Enumeration Date	:	06/23/2009
Last Update Date	:	06/23/2009

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