Provider Demographics
NPI:1326121856
Name:SHERIFF, JAY (OD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:SHERIFF
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 1:4206 KEMP BLVD
Mailing Address - Street 2:# B
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2846
Mailing Address - Country:US
Mailing Address - Phone:940-696-2653
Mailing Address - Fax:940-696-2685
Practice Address - Street 1:4206 KEMP BLVD
Practice Address - Street 2:# B
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2846
Practice Address - Country:US
Practice Address - Phone:940-696-2653
Practice Address - Fax:940-696-2685
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5971TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148908001Medicaid
TX148908001Medicaid
TXU87351Medicare UPIN