Provider Demographics
NPI:1831114198
Name:KLEIN, JAY B (OD PA)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:B
Last Name:KLEIN
Suffix:
Gender:M
Credentials:OD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 CANDLELIGHT BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-3116
Mailing Address - Country:US
Mailing Address - Phone:352-796-4833
Mailing Address - Fax:352-799-0462
Practice Address - Street 1:924 CANDLELIGHT BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-3116
Practice Address - Country:US
Practice Address - Phone:352-796-4833
Practice Address - Fax:352-799-0462
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC0001805152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078715900Medicaid
FL19300Medicare PIN
FLT84163Medicare UPIN