Provider Demographics
NPI:1851386981
Name:TUCHOWSKI, JASON G (OD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:G
Last Name:TUCHOWSKI
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:PO BOX 26010
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-6010
Mailing Address - Country:US
Mailing Address - Phone:586-296-7250
Mailing Address - Fax:586-296-0276
Practice Address - Street 1:33080 UTICA RD
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-2038
Practice Address - Country:US
Practice Address - Phone:586-296-7250
Practice Address - Fax:586-296-0276
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004164152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5189650Medicaid
MI5189640Medicaid
MI5189650Medicaid
MIP41880004Medicare ID - Type Unspecified
MI5189640Medicaid
U92702Medicare UPIN