Provider Demographics
NPI:1124783378
Name:JASON MERRELL, OD, PLLC
Entity type:Organization
Organization Name:JASON MERRELL, OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-390-0826
Mailing Address - Street 1:1661 E LUNA BLANCA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-8466
Mailing Address - Country:US
Mailing Address - Phone:208-390-0826
Mailing Address - Fax:
Practice Address - Street 1:1606 S SIGNAL BUTTE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-1482
Practice Address - Country:US
Practice Address - Phone:480-358-9737
Practice Address - Fax:480-358-9739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty