Provider Demographics
NPI:1679625107
Name:HOWARD, JASON BRIAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:BRIAN
Last Name:HOWARD
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 1:140 ADAMS LN STE 300
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3088
Mailing Address - Country:US
Mailing Address - Phone:606-432-5543
Mailing Address - Fax:606-432-0147
Practice Address - Street 1:140 ADAMS LN STE 300
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3088
Practice Address - Country:US
Practice Address - Phone:606-432-5543
Practice Address - Fax:606-432-0147
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1377DT152W00000X
MS864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77001188Medicaid
KY77001188Medicaid
KY0169Medicare PIN
KY1954801Medicare ID - Type Unspecified
KY77001188Medicaid