Provider Demographics
NPI:1114001419
Name:DR. JAY MESSINGER
Entity Type:Organization
Organization Name:DR. JAY MESSINGER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:H
Authorized Official - Last Name:MESSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-631-3660
Mailing Address - Street 1:3267 CORINTH AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-1310
Mailing Address - Country:US
Mailing Address - Phone:310-631-3660
Mailing Address - Fax:310-631-9264
Practice Address - Street 1:318 E COMPTON BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3206
Practice Address - Country:US
Practice Address - Phone:310-631-3660
Practice Address - Fax:310-631-9264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 5433T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD005570Medicaid
CAT70024Medicare UPIN
CAGSD005570Medicaid