Provider Demographics
NPI:1265729081
Name:JARSTAD, ALLISON RAE (DO)
Entity type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:RAE
Last Name:JARSTAD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 E BARNETT RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8279
Mailing Address - Country:US
Mailing Address - Phone:541-779-2020
Mailing Address - Fax:541-770-6838
Practice Address - Street 1:1408 E BARNETT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8279
Practice Address - Country:US
Practice Address - Phone:541-779-2020
Practice Address - Fax:541-770-6838
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A15543207W00000X
ORDO208852207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty