Provider Demographics
NPI:1588703318
Name:HASSON, JEFFREY S (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:HASSON
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:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:
Practice Address - Street 1:3231 S NATIONAL AVE
Practice Address - Street 2:SUITE 165
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7304
Practice Address - Country:US
Practice Address - Phone:417-820-9393
Practice Address - Fax:417-820-9725
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT002235152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO108953OtherMO BLUE SHIELD
AR124153722Medicaid
AR81588OtherARK BLUE SHIELD
MO312015316Medicaid
AR81588OtherARK BLUE SHIELD
MO000091176Medicare PIN
MO911763230Medicare PIN