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NPI Code Detail

MEDICARE: DR. ERWIN ALLEN JAY OD

MEDICARE:  DR. ERWIN ALLEN JAY  OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist2404OH

General Provider Information

NPI Number : 1235276379
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERWIN ALLEN JAY OD
Provider Business Mailing Address
First Line : 5194 WILSON MILLS ROAD
Second Line :
City : RICHMOND HEIGHTS
State : OH
Zip : 44143-3006
Country : US
Telephone Number : 440-461-2500
Fax Number : 440-461-2588
Provider Business Practice Location Address
First Line : 5194 WILSON MILLS ROAD
Second Line :
City : RICHMOND HEIGHTS
State : OH
Zip : 44143-3006
Country : US
Telephone Number : 440-461-2500
Fax Number : 440-461-2588
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2007
Last Update Date : 07/08/2007

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