Provider Demographics
NPI:1437288164
Name:MUSSON, JAY (OD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:MUSSON
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 1:375 HIGHLINE DR
Mailing Address - Street 2:
Mailing Address - City:E WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-5344
Mailing Address - Country:US
Mailing Address - Phone:509-886-0924
Mailing Address - Fax:509-886-1817
Practice Address - Street 1:375 HIGHLINE DR
Practice Address - Street 2:
Practice Address - City:E WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-5344
Practice Address - Country:US
Practice Address - Phone:509-886-0924
Practice Address - Fax:509-886-1817
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA978152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT017443Medicare UPIN