Provider Demographics
NPI:1790805554
Name:PRAVDA, JAY S (OD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:S
Last Name:PRAVDA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:S
Other - Last Name:PRAVDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:20811 HIGHWAY 59 N
Practice Address - Street 2:SUITE 300
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-2259
Practice Address - Country:US
Practice Address - Phone:281-446-2020
Practice Address - Fax:281-548-3411
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2295TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist