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General NPI Number Information
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NPI Number | 1609861608
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Entity Type | Individual
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Provider Name | JASON JAHN O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/15/2005
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Last Update Date | 02/17/2020
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Provider Practice Location Address
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Address Line | 1208 22ND AVE S
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City | BROOKINGS
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State | SD
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Zip | 57006-2804
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Country | US
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Telephone | 605-692-2020
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Fax | 605-692-9594
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Provider Business Mailing Address
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Address Line | 1208 22ND AVE S
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City | BROOKINGS
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State | SD
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Zip | 57006-0284
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Country | US
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Telephone | 605-692-2020
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Fax | 605-692-9594
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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 | 142
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License Number State | SD
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