Provider Demographics
NPI:1164588794
Name:STOLTZFUS, JAY H (OD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:H
Last Name:STOLTZFUS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17557-1298
Mailing Address - Country:US
Mailing Address - Phone:717-354-2020
Mailing Address - Fax:717-355-2020
Practice Address - Street 1:117 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:17557-1298
Practice Address - Country:US
Practice Address - Phone:717-354-2020
Practice Address - Fax:717-355-2020
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE5575P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA183530Medicare ID - Type Unspecified
PAT29993Medicare UPIN