Provider Demographics
NPI:1235276379
Name:JAY, ERWIN ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:ERWIN
Middle Name:ALLEN
Last Name:JAY
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 1:5194 WILSON MILLS ROAD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3006
Mailing Address - Country:US
Mailing Address - Phone:440-461-2500
Mailing Address - Fax:440-461-2588
Practice Address - Street 1:5194 WILSON MILLS ROAD
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-3006
Practice Address - Country:US
Practice Address - Phone:440-461-2500
Practice Address - Fax:440-461-2588
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2404152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist