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NPI Code Detail

MEDICARE: JASON COMPTON OD

MEDICARE: JASON COMPTON OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristTUV006940NY

General Provider Information

NPI Number : 1205037363
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON COMPTON OD
Provider Business Mailing Address
First Line : 4738 BROADWAY
Second Line :
City : NEW YORK
State : NY
Zip : 10040-1103
Country : US
Telephone Number : 646-661-7615
Fax Number : 646-661-7617
Provider Business Practice Location Address
First Line : 4738 BROADWAY
Second Line :
City : NEW YORK
State : NY
Zip : 10040-1103
Country : US
Telephone Number : 646-661-7615
Fax Number : 646-661-7617
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2007
Last Update Date : 04/24/2020

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