Provider Demographics
NPI:1710982095
Name:BERRY, JAY K (OD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:K
Last Name:BERRY
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 1:2020 COLORADO AVE
Mailing Address - Street 2:STE A
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2002
Mailing Address - Country:US
Mailing Address - Phone:209-667-6211
Mailing Address - Fax:209-667-2574
Practice Address - Street 1:2020 COLORADO AVE
Practice Address - Street 2:STE A
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2002
Practice Address - Country:US
Practice Address - Phone:209-667-6211
Practice Address - Fax:209-667-2574
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4483T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0044830Medicaid
CASD0044830Medicare ID - Type Unspecified
CASD0044830Medicaid