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General NPI Number Information
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NPI Number | 1104875319
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Entity Type | Individual
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Provider Name | JASON A NESHEIM OD
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Gender | Male
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 1905 E P TRUE PARKWAY STE 103
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City | WEST DES MOINES
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State | IA
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Zip | 50265
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Country | US
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Telephone | 515-225-0877
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Fax | 515-225-9518
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Provider Business Mailing Address
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Address Line | 1905 E P TRUE PARKWAY STE 103
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City | WEST DES MOINES
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State | IA
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Zip | 50265
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Country | US
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Telephone | 515-225-0877
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Fax | 515-225-9518
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 02095
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License Number State | IA
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