Provider Demographics
NPI:1720463201
Name:CHRISTMAN, JASON (OD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:CHRISTMAN
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 1:530 TERRA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-2533
Mailing Address - Country:US
Mailing Address - Phone:208-313-6622
Mailing Address - Fax:
Practice Address - Street 1:WOOD PCMH- CAMP WALKER
Practice Address - Street 2:UNIT 15021
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96218
Practice Address - Country:US
Practice Address - Phone:208-403-4543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP100331152WC0802X
IDODP-100331152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management