Provider Demographics
NPI:1093088122
Name:ERHARDT, JASON D (OD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:D
Last Name:ERHARDT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 ROCK ISLAND PL
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-7724
Mailing Address - Country:US
Mailing Address - Phone:701-258-3402
Mailing Address - Fax:
Practice Address - Street 1:2717 ROCK ISLAND PL
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-7724
Practice Address - Country:US
Practice Address - Phone:701-258-3402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND691152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist