Healthcare Provider Details

I. General information

NPI: 1467734889
Provider Name (Legal Business Name): JASON M BLEAZARD O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8503 W CLEARWATER AVE STE A
KENNEWICK WA
99336-3100
US

IV. Provider business mailing address

1515 E COLUMBIA ST
OTHELLO WA
99344-1846
US

V. Phone/Fax

Practice location:
  • Phone: 509-943-6565
  • Fax:
Mailing address:
  • Phone: 509-488-5256
  • Fax: 509-488-9939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD60231221
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: