Provider Demographics
NPI:1578597191
Name:POWELL, JASON R (OD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:R
Last Name:POWELL
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:7950 S NEW ABBEY DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-9290
Mailing Address - Country:US
Mailing Address - Phone:520-574-1028
Mailing Address - Fax:520-533-2568
Practice Address - Street 1:7395 S HOUGHTON RD
Practice Address - Street 2:SUITE 129
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-3304
Practice Address - Country:US
Practice Address - Phone:520-792-1450
Practice Address - Fax:520-664-1842
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDODP-100051152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist