Provider Demographics
NPI:1992862148
Name:EVANS, JASON MARION (OD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:MARION
Last Name:EVANS
Suffix:
Gender:
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1709 KY ROUTE 321 STE 3
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-9097
Mailing Address - Country:US
Mailing Address - Phone:606-886-8546
Mailing Address - Fax:606-886-8548
Practice Address - Street 1:6500 HIGHWAY 645
Practice Address - Street 2:STE 110
Practice Address - City:INEZ
Practice Address - State:KY
Practice Address - Zip Code:41224
Practice Address - Country:US
Practice Address - Phone:606-298-3412
Practice Address - Fax:844-858-8954
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY1637DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77001410Medicaid
KYV05948Medicare UPIN
KY77001410Medicaid