Provider Demographics
NPI:1699324400
Name:JASON HULL OD LLC
Entity type:Organization
Organization Name:JASON HULL OD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-822-7911
Mailing Address - Street 1:1471 HENDERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SANDY LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:16145-3419
Mailing Address - Country:US
Mailing Address - Phone:724-822-7911
Mailing Address - Fax:
Practice Address - Street 1:45 WILLIAMSON RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-1253
Practice Address - Country:US
Practice Address - Phone:724-589-0234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-05
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0076166690001Medicaid