MEDICARE: ANDREW W. JONES OD PC

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

General Provider Information

NPI Number	:	1578634689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREW W. JONES OD PC

Provider Business Mailing Address
First Line	:	4236 S DARRELL DR
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47403-9088
Country	:	US
Telephone Number	:	812-825-2020
Fax Number	:	812-847-8104

Provider Business Practice Location Address
First Line	:	2251 E STATE HIGHWAY 54
Second Line	:
City	:	LINTON
State	:	IN
Zip	:	47441-9498
Country	:	US
Telephone Number	:	812-847-7880
Fax Number	:	812-847-8104

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW W JONES I
Credential	:
Telephone Number	:	812-847-7880

Provider Enumeration Date	:	11/11/2006
Last Update Date	:	03/18/2008

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