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General NPI Number Information
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NPI Number | 1619449782
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Entity Type | Organization
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Legal Business Name | JAY THE EYE DOCTOR OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 12/29/2018
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Last Update Date | 12/29/2018
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Provider Practice Location Address
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Address Line | 5411 THORNWOOD DR
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City | SAN JOSE
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State | CA
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Zip | 95123-1215
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Country | US
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Telephone | 408-360-9412
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Fax | 408-360-9414
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Provider Business Mailing Address
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Address Line | 43955 S MORAY ST
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City | FREMONT
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State | CA
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Zip | 94539-5942
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Country | US
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Telephone | 510-378-8571
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. EMMANUEL DELA CRUZ II
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Credential | OD
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Telephone | 510-378-8571
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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 |
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License Number State |
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