Healthcare Provider Details

I. General information

NPI: 1588149843
Provider Name (Legal Business Name): JASON NING OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 HAMILTON BLVD
ALLENTOWN PA
18106-9113
US

IV. Provider business mailing address

5201 HAMILTON BLVD
ALLENTOWN PA
18106-9113
US

V. Phone/Fax

Practice location:
  • Phone: 610-366-1343
  • Fax: 610-366-1343
Mailing address:
  • Phone: 610-530-4444
  • Fax: 610-366-1343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV008890-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00683700
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003484
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: