Individual
DR. GREGORY DONALD JONES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
WALMART VISION CTR #2274, 200 KSW 12TH ST, FOREST LAKE, MN 55025-1609
(651) 464-9767
Mailing address
255 SOUTH SHORE DR, FOREST LAKE, MN 55025-1609
(651) 335-1846
(651) 464-6260
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1876
WI
152W00000X
Optometrist
Primary
1908
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2202278 THRU 2202296
MEDICA
MN
01
—
2202279
MEDICA
MN
01
—
5C403JO
BCBS
MN
01
—
B19461046411
MEDICAID
MN
Enumeration date
10/02/2006
Last updated
07/09/2007
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