MEDICARE: DR. JOHN B JARDING 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
1	152W00000X	Optometrist	111	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396702221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN B JARDING O.D

Provider Business Mailing Address
First Line	:	200 S CHICAGO ST
Second Line	:
City	:	HOT SPRINGS
State	:	SD
Zip	:	57747-2322
Country	:	US
Telephone Number	:	605-745-3175
Fax Number	:	605-745-4006

Provider Business Practice Location Address
First Line	:	200 S CHICAGO ST
Second Line	:
City	:	HOT SPRINGS
State	:	SD
Zip	:	57747-2322
Country	:	US
Telephone Number	:	605-745-3175
Fax Number	:	605-745-4006

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	02/27/2020

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