Provider Demographics
NPI:1891501920
Name:SLEDZ, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:SLEDZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 N MAIN ST STE 8
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-3575
Mailing Address - Country:US
Mailing Address - Phone:575-791-0559
Mailing Address - Fax:
Practice Address - Street 1:2300 N MAIN ST STE 8
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-3575
Practice Address - Country:US
Practice Address - Phone:575-762-5266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty