Provider Demographics
NPI:1508812686
Name:BRIGHT, JASON (PA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BRIGHT
Suffix:
Gender:M
Credentials:PA
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 578
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72089-0578
Mailing Address - Country:US
Mailing Address - Phone:501-653-2442
Mailing Address - Fax:501-653-2404
Practice Address - Street 1:100 BRYANT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-3812
Practice Address - Country:US
Practice Address - Phone:501-653-2442
Practice Address - Fax:501-653-2404
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2553152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR159604722Medicaid
AR159604722Medicaid
AR49899Medicare PIN