Provider Demographics
NPI:1831174606
Name:ROGERS, JASON B (OD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:B
Last Name:ROGERS
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 1:5703 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-2919
Mailing Address - Country:US
Mailing Address - Phone:913-341-4508
Mailing Address - Fax:913-341-4570
Practice Address - Street 1:5703 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-2919
Practice Address - Country:US
Practice Address - Phone:913-341-4508
Practice Address - Fax:913-341-4570
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1467-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100220590AMedicaid
KSU59424Medicare UPIN
KS100220590AMedicaid
KS0389400001Medicare NSC
KS4849054Medicare PIN