Provider Demographics
NPI:1437142205
Name:WEIL, JAY A (OD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:A
Last Name:WEIL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2223 N WEST SHORE BLVD
Mailing Address - Street 2:SUITE 169B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1411
Mailing Address - Country:US
Mailing Address - Phone:813-348-9696
Mailing Address - Fax:813-348-9191
Practice Address - Street 1:2223 N WEST SHORE BLVD
Practice Address - Street 2:SUITE 169B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1411
Practice Address - Country:US
Practice Address - Phone:813-348-9696
Practice Address - Fax:813-398-0660
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC001789152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20529ZMedicare PIN
T28728Medicare UPIN