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General NPI Number Information
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NPI Number | 1164730297
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Entity Type | Organization
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Legal Business Name | JAY ROSENFELD OD PA
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Dates
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Enumeration Date | 09/23/2010
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Last Update Date | 09/23/2010
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Provider Practice Location Address
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Address Line | 2541 COUNTRYSIDE BLVD STE 1
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City | CLEARWATER
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State | FL
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Zip | 33761-3504
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Country | US
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Telephone | 727-799-4500
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Fax | 727-724-1633
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Provider Business Mailing Address
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Address Line | 2541 COUNTRYSIDE BLVD STE 1
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City | CLEARWATER
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State | FL
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Zip | 33761-3504
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Country | US
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Telephone | 727-799-4500
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Fax | 727-724-1633
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAY ROSENFELD
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Credential | OD
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Telephone | 727-799-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC1691
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License Number State | FL
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