Individual
MR. JASON LEE ELLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
244 S. GATEWAY PLACE, SUITE 401, JENKS, OK 74037
(918) 747-2020
(918) 747-2056
Mailing address
244 S. GATEWAY PLACE, SUITE 401, JENKS, OK 74037
(918) 747-2020
(918) 747-2056
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2272
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100761000A
—
OK
01
—
2060377
UNITED HEALTHCARE
OK
01
—
7518168
AETNA
OK
Enumeration date
05/24/2005
Last updated
03/22/2019
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