Provider Demographics
NPI:1679544191
Name:WARD, JAY P (OD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:P
Last Name:WARD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:13404 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-3104
Mailing Address - Country:US
Mailing Address - Phone:918-369-2020
Mailing Address - Fax:918-369-8600
Practice Address - Street 1:13404 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-3104
Practice Address - Country:US
Practice Address - Phone:918-369-2020
Practice Address - Fax:918-369-8600
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1065152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T40705Medicare UPIN