Healthcare Provider Details

I. General information

NPI: 1104816933
Provider Name (Legal Business Name): JAY E ROFSKY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 W. LA VETA AVE SUITE 260
ORANGE CA
92868-4439
US

IV. Provider business mailing address

725 W. LA VETA AVE SUITE 260
ORANGE CA
92868-4439
US

V. Phone/Fax

Practice location:
  • Phone: 714-744-8801
  • Fax: 714-744-8630
Mailing address:
  • Phone: 714-744-8801
  • Fax: 714-744-8630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 10161 T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: