Provider Demographics
NPI:1124283148
Name:SCHAFF, JASON MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:MICHAEL
Last Name:SCHAFF
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 1:2200 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6346
Mailing Address - Country:US
Mailing Address - Phone:701-330-5269
Mailing Address - Fax:701-772-8161
Practice Address - Street 1:2200 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6346
Practice Address - Country:US
Practice Address - Phone:701-330-5269
Practice Address - Fax:701-772-8161
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND660152W00000X
MN3157152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist