Provider Demographics
NPI:1750495115
Name:DAY, JUANITA (OD)
Entity Type:Individual
Prefix:DR
First Name:JUANITA
Middle Name:
Last Name:DAY
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:PO BOX 181677
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76096-1677
Mailing Address - Country:US
Mailing Address - Phone:817-453-6329
Mailing Address - Fax:
Practice Address - Street 1:7111 MARVIN D LOVE FWY
Practice Address - Street 2:STE 101
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3112
Practice Address - Country:US
Practice Address - Phone:817-453-6329
Practice Address - Fax:682-651-5559
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2018-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3565T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0932725-03OtherCHILDREN WITH SPECIAL HEALTH CARE NEEDS (CSHCN)
TXTXB125427OtherMEDICARE
TN75-2225993OtherUNITED HEALTHCARE
40877OtherAVESIS
TX0932725-01Medicaid
TX918245OtherEYEMED VISION CARE
TX910465OtherBLOCK VISION OF TEXAS,INC
TX0065FFOtherBLUE CROSS & BLUE SHIELD
50497OtherAVESIS
T92495Medicare UPIN