Provider Demographics
NPI:1699205088
Name:TORRES, JARED (OD)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:
Last Name:TORRES
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 1:102 SYDNEE LN
Mailing Address - Street 2:
Mailing Address - City:HOLCOMB
Mailing Address - State:KS
Mailing Address - Zip Code:67851-9729
Mailing Address - Country:US
Mailing Address - Phone:620-521-9791
Mailing Address - Fax:
Practice Address - Street 1:3101 E KANSAS AVE STE 9
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-6994
Practice Address - Country:US
Practice Address - Phone:620-272-9667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2069152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist