Provider Demographics
NPI:1659860187
Name:JAY, CHARLES BRIAN (OD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:BRIAN
Last Name:JAY
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 1:225 E LEE AVE
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-8227
Mailing Address - Country:US
Mailing Address - Phone:336-679-2931
Mailing Address - Fax:336-677-6486
Practice Address - Street 1:225 E LEE AVE
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-8227
Practice Address - Country:US
Practice Address - Phone:336-679-2931
Practice Address - Fax:336-677-6486
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2528152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist