Provider Demographics
NPI:1144353228
Name:EDWARD LAWRENCE JONES & ASSOC
Entity type:Organization
Organization Name:EDWARD LAWRENCE JONES & ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-941-2000
Mailing Address - Street 1:13530 SE 181ST PL
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-6806
Mailing Address - Country:US
Mailing Address - Phone:206-941-2000
Mailing Address - Fax:425-235-0840
Practice Address - Street 1:601 W GOWE ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5745
Practice Address - Country:US
Practice Address - Phone:253-854-2028
Practice Address - Fax:253-854-2744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1651152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2030187Medicaid
WAG8880384OtherMEDICARE PTAN
WAG8880384Medicare PIN
WAG8880384OtherMEDICARE PTAN