Provider Demographics
NPI:1912927450
Name:RHYNES, JASON K (OD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:K
Last Name:RHYNES
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 1426
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74702-1426
Mailing Address - Country:US
Mailing Address - Phone:580-920-2020
Mailing Address - Fax:580-924-5656
Practice Address - Street 1:1901 W UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3076
Practice Address - Country:US
Practice Address - Phone:580-920-2020
Practice Address - Fax:580-924-5656
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2373152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100766330AMedicaid
OKU92367Medicare UPIN
OKOK700027Medicare PIN