Provider Demographics
NPI:1255472775
Name:KAUFMAN, JAY STEPHEN (OD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:STEPHEN
Last Name:KAUFMAN
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 1:22850 NE 8TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-7256
Mailing Address - Country:US
Mailing Address - Phone:425-868-3622
Mailing Address - Fax:
Practice Address - Street 1:22850 NE 8TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7256
Practice Address - Country:US
Practice Address - Phone:425-868-3622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD3160TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist