Healthcare Provider Details

I. General information

NPI: 1437288164
Provider Name (Legal Business Name): JAY MUSSON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 HIGHLINE DR
E WENATCHEE WA
98802-5344
US

IV. Provider business mailing address

375 HIGHLINE DR
E WENATCHEE WA
98802-5344
US

V. Phone/Fax

Practice location:
  • Phone: 509-886-0924
  • Fax: 509-886-1817
Mailing address:
  • Phone: 509-886-0924
  • Fax: 509-886-1817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number978
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: