Provider Demographics
NPI:1760535306
Name:SHELBY, JAY (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:
Last Name:SHELBY
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5570 LAKESIDE DR
Mailing Address - Street 2:APT 201
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-7652
Mailing Address - Country:US
Mailing Address - Phone:954-972-6151
Mailing Address - Fax:954-974-8252
Practice Address - Street 1:2420 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5720
Practice Address - Country:US
Practice Address - Phone:954-978-7732
Practice Address - Fax:954-974-8252
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL1835156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician