Provider Demographics
NPI:1356339378
Name:HALES, JASON B (OD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:B
Last Name:HALES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:504 PINE LOG RUN
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-7376
Mailing Address - Country:US
Mailing Address - Phone:845-238-7159
Mailing Address - Fax:
Practice Address - Street 1:350 HARBISON BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-2248
Practice Address - Country:US
Practice Address - Phone:803-749-6878
Practice Address - Fax:803-749-6089
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002019563152W00000X
SC2299152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist