Provider Demographics
NPI:1023144607
Name:KAVANAGH, JAY ARTHUR (OD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:ARTHUR
Last Name:KAVANAGH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 BRENTVIEW CT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37220-1508
Mailing Address - Country:US
Mailing Address - Phone:615-837-9096
Mailing Address - Fax:615-859-3049
Practice Address - Street 1:2232 GALLATIN PIKE N
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2006
Practice Address - Country:US
Practice Address - Phone:615-855-0990
Practice Address - Fax:615-859-3049
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1616152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3942484Medicare ID - Type Unspecified
TNU-53913Medicare UPIN