Provider Demographics
NPI:1790771822
Name:TAYLOR, JAY C II (OD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:C
Last Name:TAYLOR
Suffix:II
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 1:18979 COASTAL HWY UNIT 201
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-6222
Mailing Address - Country:US
Mailing Address - Phone:302-470-9616
Mailing Address - Fax:
Practice Address - Street 1:18979 COASTAL HWY UNIT 201
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-6222
Practice Address - Country:US
Practice Address - Phone:302-470-9616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI3-1234152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEU67822Medicare UPIN