Provider Demographics
NPI:1437154044
Name:HENRY, JAY WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:WILLIAM
Last Name:HENRY
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 1:650 HILL RD N
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9201
Mailing Address - Country:US
Mailing Address - Phone:614-833-2400
Mailing Address - Fax:614-833-6559
Practice Address - Street 1:650 HILL RD N
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9201
Practice Address - Country:US
Practice Address - Phone:614-833-2400
Practice Address - Fax:614-833-6559
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH 4937 / T1807152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2105617Medicaid
OH2105617Medicaid
OH0872302Medicare PIN