Provider Demographics
NPI:1821681388
Name:WARD, ANDERSON JAY III (CCP)
Entity Type:Individual
Prefix:MR
First Name:ANDERSON
Middle Name:JAY
Last Name:WARD
Suffix:III
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7316 DEL CIELO WAY
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-8845
Mailing Address - Country:US
Mailing Address - Phone:209-985-1777
Mailing Address - Fax:
Practice Address - Street 1:7316 DEL CIELO WAY
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-8845
Practice Address - Country:US
Practice Address - Phone:209-985-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty