Provider Demographics
NPI:1124109848
Name:PEARSON, JARED CARL (OD)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:CARL
Last Name:PEARSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:318 MOUNT RUSHMORE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-2769
Mailing Address - Country:US
Mailing Address - Phone:605-399-3937
Mailing Address - Fax:
Practice Address - Street 1:318 MOUNT RUSHMORE RD
Practice Address - Street 2:SUITE A
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2769
Practice Address - Country:US
Practice Address - Phone:605-399-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD608152W00000X, 152WC0802X, 152WS0006X, 152WV0400X, 152WP0200X, 152WX0102X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDV06566Medicare UPIN