MEDICARE: MR. MARCUS JONES

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	263146320	TX

General Provider Information

NPI Number	:	1740438662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARCUS JONES

Provider Business Mailing Address
First Line	:	5811 BERKMAN DR
Second Line	:	121
City	:	AUSTIN
State	:	TX
Zip	:	78723-2666
Country	:	US
Telephone Number	:	512-926-2400
Fax Number	:	512-926-2608

Provider Business Practice Location Address
First Line	:	5811 BERKMAN DR
Second Line	:	121
City	:	AUSTIN
State	:	TX
Zip	:	78723-2666
Country	:	US
Telephone Number	:	512-926-2400
Fax Number	:	512-926-2608

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

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	09/04/2008

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