Provider Demographics
NPI:1407891401
Name:BATES, JASON K (OD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:K
Last Name:BATES
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 1:221 W STEWART AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501
Mailing Address - Country:US
Mailing Address - Phone:541-776-9026
Mailing Address - Fax:541-776-9096
Practice Address - Street 1:221 W STEWART AVE
Practice Address - Street 2:STE 110
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501
Practice Address - Country:US
Practice Address - Phone:541-776-9026
Practice Address - Fax:541-776-9096
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3136AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213444Medicaid
V08299Medicare UPIN
ORV08299Medicare UPIN
OR133955Medicare PIN
OR213444Medicaid