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NPI Code Detail

MEDICARE: DR. JASON PIANT O. D.

MEDICARE: DR. JASON PIANT O. D.
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
1152W00000XOptometrist3219MN

General Provider Information

NPI Number : 1275780470
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JASON PIANT O. D.
Provider Business Mailing Address
First Line : 5817 IVY LN
Second Line :
City : MINNETONKA
State : MN
Zip : 55345-5314
Country : US
Telephone Number : 303-887-6631
Fax Number :
Provider Business Practice Location Address
First Line : 3500 W PETERSON AVE STE 401
Second Line :
City : CHICAGO
State : IL
Zip : 60659-3307
Country : US
Telephone Number : 773-588-3090
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2008
Last Update Date : 08/24/2021

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