MEDICARE: DR. JASON D ERHARDT O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	691	ND

General Provider Information

NPI Number	:	1093088122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON D ERHARDT O.D.

Provider Business Mailing Address
First Line	:	2717 ROCK ISLAND PL
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58504-7724
Country	:	US
Telephone Number	:	701-258-3402
Fax Number	:

Provider Business Practice Location Address
First Line	:	2717 ROCK ISLAND PL
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58504-7724
Country	:	US
Telephone Number	:	701-258-3402
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2012
Last Update Date	:	09/23/2013

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