Provider Demographics
NPI:1104875319
Name:NESHEIM, JASON A (OD)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:A
Last Name:NESHEIM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 E P TRUE PARKWAY
Mailing Address - Street 2:STE 103
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265
Mailing Address - Country:US
Mailing Address - Phone:515-225-0877
Mailing Address - Fax:515-225-9518
Practice Address - Street 1:1905 E P TRUE PARKWAY
Practice Address - Street 2:STE 103
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265
Practice Address - Country:US
Practice Address - Phone:515-225-0877
Practice Address - Fax:515-225-9518
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02095152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0158865Medicaid
IA1158865Medicaid
IA3158865Medicaid
IA2158865Medicaid
IA2158865Medicaid
40514Medicare PIN
40513Medicare PIN
IA0158865Medicaid
IA3158865Medicaid
410037007Medicare PIN
410037006Medicare PIN
410037008Medicare PIN
410037009Medicare PIN