Provider Demographics
NPI:1174766430
Name:JASON JAHN OD PC
Entity type:Organization
Organization Name:JASON JAHN OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:C
Authorized Official - Last Name:JAHN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-692-2020
Mailing Address - Street 1:1100 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2206
Mailing Address - Country:US
Mailing Address - Phone:605-692-2020
Mailing Address - Fax:605-692-9594
Practice Address - Street 1:1100 6TH ST
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2206
Practice Address - Country:US
Practice Address - Phone:605-692-2020
Practice Address - Fax:605-692-9594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD142152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9201102Medicaid
SDP00084283OtherRAILROAD MEDICARE
SD22104OtherSIOUX VALLEY HEALTH
MN4C035JAOtherBCBS OF MN
SD0073102OtherBCBS OF SD
SD419OtherDAKOTA CARE
SD419OtherDAKOTA CARE
SDS73102Medicare PIN