Provider Demographics
NPI:1548281066
Name:WASYLOVSKI, JASON M (OD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:M
Last Name:WASYLOVSKI
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 1:460 MARKMAN PARK RD
Mailing Address - Street 2:
Mailing Address - City:BADEN
Mailing Address - State:PA
Mailing Address - Zip Code:15005-2838
Mailing Address - Country:US
Mailing Address - Phone:347-678-2877
Mailing Address - Fax:
Practice Address - Street 1:175 QUINN DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15275-1013
Practice Address - Country:US
Practice Address - Phone:412-788-1691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000079152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02524629Medicaid
NYC323E2Medicare ID - Type Unspecified
U99327Medicare UPIN