Provider Demographics
NPI:1578545828
Name:ORTMAN, JASON TROY (OD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:TROY
Last Name:ORTMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:250 MAX DR
Mailing Address - Street 2:101
Mailing Address - City:CASTLE PINES
Mailing Address - State:CO
Mailing Address - Zip Code:80108-9517
Mailing Address - Country:US
Mailing Address - Phone:303-688-5066
Mailing Address - Fax:303-688-6986
Practice Address - Street 1:250 MAX DR
Practice Address - Street 2:101
Practice Address - City:CASTLE PINES
Practice Address - State:CO
Practice Address - Zip Code:80108-9517
Practice Address - Country:US
Practice Address - Phone:303-688-5066
Practice Address - Fax:303-688-6986
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2238152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO803357OtherGROUP MIDWEST EYE ASSOC
CO803357OtherGROUP MIDWEST EYE ASSOC
V06639Medicare UPIN