Provider Demographics
NPI:1790865665
Name:HULL, JASON WAYNE
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:WAYNE
Last Name:HULL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 HENDERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SANDY LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:16145-3419
Mailing Address - Country:US
Mailing Address - Phone:724-376-3785
Mailing Address - Fax:814-864-0398
Practice Address - Street 1:200 MILLCREEK PLZ
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16565-1102
Practice Address - Country:US
Practice Address - Phone:814-864-4858
Practice Address - Fax:814-864-0398
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA OEG000291152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA397164OtherNAT'L VISION ADMIN (NVA)
PA376280OtherBLUE CROSS BLUE SHIELD
PA397164OtherNAT'L VISION ADMIN (NVA)
PAU76113Medicare UPIN