Provider Demographics
NPI:1922191808
Name:TAYLOR, JAMIE LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LYNN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 A1A N STE 13
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3228
Mailing Address - Country:US
Mailing Address - Phone:904-686-1386
Mailing Address - Fax:904-686-1363
Practice Address - Street 1:880 A1A N STE 13
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3228
Practice Address - Country:US
Practice Address - Phone:904-686-1386
Practice Address - Fax:904-686-1363
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3950152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist