Provider Demographics
NPI:1730159609
Name:KUNSMAN, JASON R (OD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:R
Last Name:KUNSMAN
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 1:306 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:OH
Mailing Address - Zip Code:43543-1018
Mailing Address - Country:US
Mailing Address - Phone:419-485-4257
Mailing Address - Fax:419-485-3520
Practice Address - Street 1:306 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:OH
Practice Address - Zip Code:43543-1018
Practice Address - Country:US
Practice Address - Phone:419-485-4257
Practice Address - Fax:419-485-3520
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5049152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0090982Medicaid
OHP00291522OtherRAILROAD MEDICARE
OH0235340001Medicare NSC
OHU78331Medicare UPIN
OH0090982Medicaid