MEDICARE: DR. JASON KELSEY MACLAUGHLIN 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
1	152W00000X	Optometrist	TUV006542-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	161578122	OTHER	NY	NORTH AMERICAN PREFERRED
2	7290238	OTHER	NY	INDEPENDENT HEALTH
3	161578122	OTHER	NY	EMPIRE - UNITED HEALTHCAR
4	161578122	OTHER	NY	NOVA
5	251744484	OTHER	NY	EMPIRE - UNITED HEALTHCAR
6	251744484	OTHER	NY	NORTH AMERICAN PREFERRED
7	251744484	OTHER	NY	NOVA
8	000390213003	OTHER	NY	COMMUNITY BLUE

General Provider Information

NPI Number	:	1235134313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON KELSEY MACLAUGHLIN OD

Provider Business Mailing Address
First Line	:	5942 DONEGAL MNR
Second Line	:
City	:	CLARENCE CENTER
State	:	NY
Zip	:	14032-9506
Country	:	US
Telephone Number	:	716-480-5425
Fax Number	:

Provider Business Practice Location Address
First Line	:	8195 SHERIDAN DR
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-6002
Country	:	US
Telephone Number	:	716-631-3860
Fax Number	:	716-276-3467

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	08/25/2023

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