Healthcare Provider Details

I. General information

NPI: 1932174018
Provider Name (Legal Business Name): JAY ANANTHAN-NAIR, OD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 N US HIGHWAY 17/92
DEBARY FL
32713-2519
US

IV. Provider business mailing address

38 N US HIGHWAY 17/92
DEBARY FL
32713-2519
US

V. Phone/Fax

Practice location:
  • Phone: 386-668-0600
  • Fax:
Mailing address:
  • Phone: 386-668-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. JAY ANANTHAN-NAIR
Title or Position: PRESIDENT
Credential: OD, PHD
Phone: 386-668-0600