Provider Demographics
NPI:1609861608
Name:JAHN, JASON (OD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:JAHN
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 1:1208 22ND AVE S
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-0284
Mailing Address - Country:US
Mailing Address - Phone:605-692-2020
Mailing Address - Fax:605-692-9594
Practice Address - Street 1:1208 22ND AVE S
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2804
Practice Address - Country:US
Practice Address - Phone:605-692-2020
Practice Address - Fax:605-692-9594
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD142152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD22104OtherSIOUX VALLEY HEALTH
SD0073102OtherBCBS OF SD
MN4C035JAOtherBCBS OF MN
SDP00815934OtherRAILROAD MEDICARE
SD9280170Medicaid
SD419OtherDAKOTA CARE
SD22104OtherSIOUX VALLEY HEALTH
SD9280170Medicaid