Active NPI
Gregory Donald Jones, O.D.
- Optometrist
- Forest Lake, MN
National Provider Identifier
1295829752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1908
- Practice address
- Walmart Vision Ctr #2274
200 KSW 12TH St
Forest Lake, MN 55025-1609 - Phone
- (651) 464-9767
- NPI assigned
- Oct 2, 2006
- Last updated
- Jul 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1908 | MN | Primary |
| Optometrist | 152W00000X | 1876 | WI |
Addresses
Primary practice location
Walmart Vision Ctr #2274
200 KSW 12TH St
Forest Lake, MN 55025-1609
Mailing address
255 South Shore Dr
Forest Lake, MN 55025-1609
Phone (651) 335-1846
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1908 | MN | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thomas N Johnson Optometric Corp | Optometrist | Past | Accepting new patients |
| Apolade Inc | Optometrist | Past | Accepting new patients |
| DT Vision Care L.L.C. | Optometrist | Past | Accepting new patients |
| Walmart Inc. | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- NPI 1760798441
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- Optometrist
- Sauk Rapids, MN
- NPI 1275772790
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1295829752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "255 SOUTH SHORE DR",
"city": "FOREST LAKE",
"state": "MN",
"postal_code": "550251609",
"telephone_number": "651-335-1846",
"fax_number": "651-464-6260"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "WALMART VISION CTR #2274",
"address_2": "200 KSW 12TH ST",
"city": "FOREST LAKE",
"state": "MN",
"postal_code": "550251609",
"telephone_number": "651-464-9767"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JONES",
"first_name": "GREGORY",
"middle_name": "DONALD",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "1908",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WI",
"license": "1876",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Forest Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.