Provider Demographics
NPI:1811075401
Name:TASLER, JEAN M (OD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:TASLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1819 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-4841
Mailing Address - Country:US
Mailing Address - Phone:507-387-4227
Mailing Address - Fax:507-345-7156
Practice Address - Street 1:1819 ADAMS ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4841
Practice Address - Country:US
Practice Address - Phone:507-387-4227
Practice Address - Fax:507-345-7156
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2216152W00000X
MN6424033152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5553960001Medicare NSC