Provider Demographics
NPI:1528255924
Name:JOHN B. JARDING OD, LLC
Entity type:Organization
Organization Name:JOHN B. JARDING OD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:JARDING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-343-4703
Mailing Address - Street 1:825 COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-4803
Mailing Address - Country:US
Mailing Address - Phone:605-343-4703
Mailing Address - Fax:605-721-7201
Practice Address - Street 1:825 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-4803
Practice Address - Country:US
Practice Address - Phone:605-343-4703
Practice Address - Fax:605-721-7201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-29
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD111152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDT66663Medicare UPIN