Individual
JASON GERARD JEDLICKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
744 E 3RD ST, BLOOMINGTON, IN 47405-3603
(812) 855-8436
(812) 855-1683
Mailing address
744 E 3RD ST, BLOOMINGTON, IN 47405-3603
(812) 855-8436
(812) 855-1683
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003875
IN
152W00000X
Optometrist
2631
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201259190
—
IN
05
—
638817500
—
MN
Enumeration date
08/11/2006
Last updated
01/12/2026
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