Provider Demographics
NPI:1619581683
Name:KAY, DENNISE (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNISE
Middle Name:
Last Name:KAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 S STAPLEY DR STE 103
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6650
Mailing Address - Country:US
Mailing Address - Phone:480-691-3917
Mailing Address - Fax:
Practice Address - Street 1:1855 S STAPLEY DR STE 103
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6650
Practice Address - Country:US
Practice Address - Phone:480-691-3917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-07
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002460152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty