Provider Demographics
NPI:1275731101
Name:RICKS, JASON ALEX (OD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ALEX
Last Name:RICKS
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:PO BOX 59
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-0059
Mailing Address - Country:US
Mailing Address - Phone:406-535-2020
Mailing Address - Fax:406-535-3210
Practice Address - Street 1:119 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-1710
Practice Address - Country:US
Practice Address - Phone:406-535-5488
Practice Address - Fax:406-535-3210
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT789152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0484245Medicaid
MT000084800OtherGROUP MEDICARE
MT011000654OtherMEDICARE PTAN
MT1245217199OtherBILLING PROVIDER NPI
MT25603OtherBLUE CROSS BLUE SHIELD