Organization
JASON EVANS OD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON MARION EVANS OD (OPTOMETRIST)
(606) 789-0343
Entity
Organization
Contact information
Practice address
470 N MAYO TRL, PAINTSVILLE, KY 41240-1806
(606) 789-0343
Mailing address
PO BOX 1301, INEZ, KY 41224-1301
(606) 789-0343
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1637DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77001410
—
KY
Enumeration date
01/16/2008
Last updated
01/16/2008
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