Provider Demographics
NPI:1538454533
Name:JONES, TONYA MARIE
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:MARIE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4131
Mailing Address - Country:US
Mailing Address - Phone:301-490-5368
Mailing Address - Fax:301-490-5368
Practice Address - Street 1:351 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4131
Practice Address - Country:US
Practice Address - Phone:301-490-5368
Practice Address - Fax:301-490-5368
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
02413211156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician