Provider Demographics
NPI:1689880478
Name:RICH, JASON PATRICK (OD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:PATRICK
Last Name:RICH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2314 DUBOIS DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3213
Mailing Address - Country:US
Mailing Address - Phone:574-269-1849
Mailing Address - Fax:574-269-1429
Practice Address - Street 1:2314 DUBOIS DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3213
Practice Address - Country:US
Practice Address - Phone:574-269-1849
Practice Address - Fax:574-269-1429
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003122152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist