Healthcare Provider Details

I. General information

NPI: 1346223831
Provider Name (Legal Business Name): JAY E. HIGHLAND OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 W. MILL ST.
BAYFIELD CO
81122
US

IV. Provider business mailing address

PO BOX 560
BAYFIELD CO
81122-0560
US

V. Phone/Fax

Practice location:
  • Phone: 970-884-2020
  • Fax: 970-884-2977
Mailing address:
  • Phone: 970-884-2020
  • Fax: 970-884-2977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-874
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT-874
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOPT-874
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberOPT-874
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: