MEDICARE: DR. JAY K BERRY O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4483T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710982095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY K BERRY O.D.

Provider Business Mailing Address
First Line	:	2020 COLORADO AVE
Second Line	:	STE A
City	:	TURLOCK
State	:	CA
Zip	:	95382-2002
Country	:	US
Telephone Number	:	209-667-6211
Fax Number	:	209-667-2574

Provider Business Practice Location Address
First Line	:	2020 COLORADO AVE
Second Line	:	STE A
City	:	TURLOCK
State	:	CA
Zip	:	95382-2002
Country	:	US
Telephone Number	:	209-667-6211
Fax Number	:	209-667-2574

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/08/2007

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