Provider Demographics
NPI:1578761136
Name:JASON B. HOWARD, O.D. L.L.C.
Entity Type:Organization
Organization Name:JASON B. HOWARD, O.D. L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-986-3759
Mailing Address - Street 1:120 JILL DR
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-1677
Mailing Address - Country:US
Mailing Address - Phone:859-986-3759
Mailing Address - Fax:
Practice Address - Street 1:120 JILL DR
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1677
Practice Address - Country:US
Practice Address - Phone:859-986-3759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0043107152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77001188Medicaid
KY1954801Medicare ID - Type Unspecified
KY77001188Medicaid