Provider Demographics
NPI:1316907314
Name:JOST, JASON M (OD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:M
Last Name:JOST
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 1:710 N CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5122
Mailing Address - Country:US
Mailing Address - Phone:719-632-1587
Mailing Address - Fax:719-632-1563
Practice Address - Street 1:710 N CIRCLE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5122
Practice Address - Country:US
Practice Address - Phone:719-632-1587
Practice Address - Fax:719-632-1563
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0532770001Medicare NSC
COC0300929Medicare PIN
COV08513Medicare UPIN