Provider Demographics
NPI:1003860313
Name:WICKENS, JASON CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:CRAIG
Last Name:WICKENS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:653 N TOWN CENTER DR STE 518
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0519
Mailing Address - Country:US
Mailing Address - Phone:702-202-4776
Mailing Address - Fax:702-243-8383
Practice Address - Street 1:653 N TOWN CENTER DR STE 518
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0519
Practice Address - Country:US
Practice Address - Phone:702-369-0200
Practice Address - Fax:702-243-8383
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2024-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV11776207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1003860313Medicaid
H82555Medicare UPIN