Provider Demographics
NPI:1164630588
Name:JASON JOST OD PC
Entity Type:Organization
Organization Name:JASON JOST OD PC
Other - Org Name:PIKES PEAK EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOST
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:719-632-1587
Mailing Address - Street 1:710 N CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909
Mailing Address - Country:US
Mailing Address - Phone:719-632-1587
Mailing Address - Fax:719-632-1563
Practice Address - Street 1:710 N CIRCLE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909
Practice Address - Country:US
Practice Address - Phone:719-632-1587
Practice Address - Fax:719-632-1563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
CO867152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08008674Medicaid
COT60755Medicare UPIN
CO0290830001Medicare NSC
COCG2508Medicare PIN
CO08008674Medicaid