Provider Demographics
NPI:1134974561
Name:HEATHER JONES OD LLC
Entity type:Organization
Organization Name:HEATHER JONES OD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-889-3182
Mailing Address - Street 1:7175 HEADLEY ST SE STE 100
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-9900
Mailing Address - Country:US
Mailing Address - Phone:616-271-0988
Mailing Address - Fax:616-271-0989
Practice Address - Street 1:7175 HEADLEY ST SE STE 100
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-9900
Practice Address - Country:US
Practice Address - Phone:616-271-0988
Practice Address - Fax:616-271-0989
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEATHER JONES OD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-19
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4901004756OtherLICENSE