Organization
MOUNT VERNON VISION SOURCE PS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TOD W JONES O.D. (OWNER)
(360) 424-4181
Entity
Organization
Contact information
Practice address
1616 N 18TH ST STE 104, MOUNT VERNON, WA 98273-2600
(360) 424-4181
(360) 424-6414
Mailing address
1616 N 18TH ST STE 104, MOUNT VERNON, WA 98273-2600
(360) 424-4181
(360) 424-6414
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD00003502
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2024057
—
WA
01
—
410044967
RR MEDICARE
WA
Enumeration date
07/02/2007
Last updated
10/14/2015
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