Street, Jason Travers
Street, Jason Travers is an individual health care provider with primary practice located at 102 Westmount Drive , Farmington MO 63640-0829. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Street, Jason Travers can be contacted via phone (573) 756-3170.Contact Information
Primary practice address
102 Westmount Drive
Farmington MO 63640-0829
Phone: (573) 756-3170
Fax: (573) 756-0173
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2000160791 | Missouri |
Profile Details
| NPI number | 1467511105 |
|---|---|
| LBN Legal business name | Street, Jason Travers |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 8th, 2006 |
| Last updated | Jan 15th, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1467511105 | NPPES |
| Missouri | MEDICAID | 315093518 |
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