Provider Demographics
NPI:1922416825
Name:BYRD, JAYANNA D (OD)
Entity Type:Individual
Prefix:
First Name:JAYANNA
Middle Name:D
Last Name:BYRD
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 1:501 E KOLSTAD ST
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-2352
Mailing Address - Country:US
Mailing Address - Phone:903-731-4653
Mailing Address - Fax:903-723-5550
Practice Address - Street 1:928 S BOLTON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-2906
Practice Address - Country:US
Practice Address - Phone:903-586-7900
Practice Address - Fax:903-586-4373
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8390T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX345170001Medicaid