Provider Demographics
NPI:1053792986
Name:JASS, RYAN (OD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:JASS
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 1:19635 S SKYE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-8800
Mailing Address - Country:US
Mailing Address - Phone:815-953-0471
Mailing Address - Fax:
Practice Address - Street 1:986 S BARTLETT RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-6500
Practice Address - Country:US
Practice Address - Phone:630-837-7630
Practice Address - Fax:630-837-3292
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046 010875152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist