Provider Demographics
NPI:1356355168
Name:DAUGHTRY, JASON R (OD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:R
Last Name:DAUGHTRY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:315 N SAN SABA
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3154
Mailing Address - Country:US
Mailing Address - Phone:210-271-7575
Mailing Address - Fax:210-225-8619
Practice Address - Street 1:315 N SAN SABA
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3154
Practice Address - Country:US
Practice Address - Phone:210-271-7575
Practice Address - Fax:210-225-8619
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX6281TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183257802Medicaid
TX183257802Medicaid
TX8F6932Medicare PIN