Provider Demographics
NPI:1275780470
Name:PIANT, JASON (O D)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:PIANT
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5817 IVY LN
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-5314
Mailing Address - Country:US
Mailing Address - Phone:303-887-6631
Mailing Address - Fax:
Practice Address - Street 1:3500 W PETERSON AVE STE 401
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3307
Practice Address - Country:US
Practice Address - Phone:773-588-3090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3219152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH40019063Medicare PIN