NPI Record of JASON EVANS OD LLC NPI 1023294303

Optometrist in Paintsville, KY

Complete NPI Record

Field Name Value Definition
NPI1023294303The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code2Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EINUNAVAILThe Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business NameJASON EVANS OD LLCThe name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing AddressPO BOX 1301The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City NameINEZThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameKYThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code412241301The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number6067890343The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address470 N MAYO TRLThe first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NamePAINTSVILLEThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameKYThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code412401806The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number6067890343The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date1/16/2008The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date1/16/2008The date that a record was last updated or changed.
Authorized Official Last NameEVANSThe last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameJASONThe first name of the authorized official.
Authorized Official Middle NameMARIONThe middle name of the authorized official.
Authorized Official Title or PositionOPTOMETRISTThe title or position of the authorized official.
Authorized Official Telephone Number6067890343The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1152W00000XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 11637DTThe license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1KYThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1Y
Other Provider Identifier 177001410Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 105Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1KY
Is Organization SubpartN
Authorized Official Name Prefix TextDR.
Authorized Official Credential TextOD
Healthcare Provider Taxonomy Group 1193400000X SINGLE SPECIALTY GROUP