Provider Demographics
NPI:1003063306
Name:SHAY, JAMIE MARIE (OD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MARIE
Last Name:SHAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:MARIE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:850 W NORTH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3196
Mailing Address - Country:US
Mailing Address - Phone:517-841-3027
Mailing Address - Fax:517-817-0144
Practice Address - Street 1:1515 LAKE LANSING RD STE H
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3752
Practice Address - Country:US
Practice Address - Phone:517-487-6511
Practice Address - Fax:517-487-1331
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004495152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist