Provider Demographics
NPI:1942276464
Name:JASIAK, RICHARD L (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:JASIAK
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 1:18 GRANITE ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-5531
Mailing Address - Country:US
Mailing Address - Phone:978-374-2010
Mailing Address - Fax:978-469-9329
Practice Address - Street 1:18 GRANITE ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01832-5531
Practice Address - Country:US
Practice Address - Phone:978-374-2010
Practice Address - Fax:978-469-9329
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA3157152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0353698Medicaid
MA0353698Medicaid
MAT59406Medicare UPIN