Healthcare Provider Details

I. General information

NPI: 1235184615
Provider Name (Legal Business Name): JASON TODD RANSDELL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7727 W DEER VALLEY RD SUITE E-2
PEORIA AZ
85382-2116
US

IV. Provider business mailing address

14269 N 87TH ST STE 203
SCOTTSDALE AZ
85260-3695
US

V. Phone/Fax

Practice location:
  • Phone: 623-376-9070
  • Fax:
Mailing address:
  • Phone: 480-483-8882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1277
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: