Provider Demographics
NPI:1457323552
Name:CHRETIEN, JAY E (OD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:E
Last Name:CHRETIEN
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 1:870 INMAN VILLAGE PKWY NE STE 3
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-5543
Mailing Address - Country:US
Mailing Address - Phone:404-589-0822
Mailing Address - Fax:404-589-4766
Practice Address - Street 1:870 INMAN VILLAGE PKWY NE STE 3
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-5543
Practice Address - Country:US
Practice Address - Phone:404-589-0822
Practice Address - Fax:404-589-4766
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ956207W00000X
GA002316152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU89910Medicare UPIN