Provider Demographics
NPI:1437119880
Name:KLESSMAN, JAY LAWRENCE (OD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:LAWRENCE
Last Name:KLESSMAN
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 1:900 17TH ST NW
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-2501
Mailing Address - Country:US
Mailing Address - Phone:202-331-7566
Mailing Address - Fax:
Practice Address - Street 1:900 17TH ST NW
Practice Address - Street 2:SUITE 400
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-2501
Practice Address - Country:US
Practice Address - Phone:202-331-7566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOP403152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T31052Medicare UPIN
T31052Medicare UPIN