Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1671 | KS |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 1671 | KS |
N | 152WP0200X | Pediatric Optomitrist | 1671 | KS |
N | 152WS0006X | Sports Vision | 1671 | KS |
NPI | 1063449189 |
---|---|
Provider Name | Dr. Jason Richard Pingel |
First Address | Mission, KS 66202-3333 |
Second Address | Mission, KS 66202-3333 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 19/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200419080A | (05) | KS |
U82931 | (02) |