Provider Demographics
NPI:1235275983
Name:HAWLEY, JASON L (OD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:L
Last Name:HAWLEY
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 1:1221 S EMORY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6373
Mailing Address - Country:US
Mailing Address - Phone:308-534-5838
Mailing Address - Fax:
Practice Address - Street 1:510 E PHILIP AVE
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5538
Practice Address - Country:US
Practice Address - Phone:308-534-7271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3053-035152W00000X
NE1272152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist