Provider Demographics
NPI:1154309789
Name:GRIFFITH, JASON C (OD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:C
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:140 W HILLCREST DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4221
Mailing Address - Country:US
Mailing Address - Phone:805-497-6964
Mailing Address - Fax:
Practice Address - Street 1:140 W HILLCREST DR
Practice Address - Street 2:SUITE 112
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4221
Practice Address - Country:US
Practice Address - Phone:805-497-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11638T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11638TOtherCALIFORNIA BOARD OF OPTOMETRY
CA1154309789OtherNPI
CA1154309789OtherNPI
CA11638TOtherCALIFORNIA BOARD OF OPTOMETRY
CAWY211Medicare PIN