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General NPI Number Information
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NPI Number | 1235275983
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Entity Type | Individual
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Provider Name | JASON L HAWLEY O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 09/02/2014
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Provider Practice Location Address
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Address Line | 510 E PHILIP AVE
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City | NORTH PLATTE
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State | NE
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Zip | 69101-5538
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Country | US
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Telephone | 308-534-7271
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 S EMORY AVE
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City | NORTH PLATTE
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State | NE
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Zip | 69101-6373
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Country | US
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Telephone | 308-534-5838
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Fax |
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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 | 3053-035
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1272
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License Number State | NE
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