Provider Demographics
NPI:1356336671
Name:VARNER, JASON LEE (OD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:LEE
Last Name:VARNER
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 1:7211 SAINT JAMES ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2758
Mailing Address - Country:US
Mailing Address - Phone:262-754-4880
Mailing Address - Fax:262-754-9814
Practice Address - Street 1:19035 W CAPITOL DR
Practice Address - Street 2:SUITE 106
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-2706
Practice Address - Country:US
Practice Address - Phone:262-754-4880
Practice Address - Fax:262-754-9814
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI2821-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU81931Medicare UPIN