Provider Demographics
NPI:1225120660
Name:GIM, JASON I (OD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:I
Last Name:GIM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9115 S TACOMA WAY
Mailing Address - Street 2:#106
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98499
Mailing Address - Country:US
Mailing Address - Phone:253-588-4225
Mailing Address - Fax:253-588-4402
Practice Address - Street 1:9115 S TACOMA WAY
Practice Address - Street 2:#106
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98499
Practice Address - Country:US
Practice Address - Phone:253-588-4225
Practice Address - Fax:253-588-4402
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3284152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7125OtherMEDICAL EYE SERVICE
WAWA3284OtherEYEMED VISION
WA625443OtherVISION CARE PLAN
WAWA0716OtherNORTHWEST BENEFIT NETWORK
WAGI6814OtherREGENCE BLUE SHIELD
WA2019529Medicaid
WAGI6814OtherREGENCE BLUE SHIELD
WAU62444Medicare UPIN
WA8853959Medicare ID - Type UnspecifiedFACILITY ID