Provider Demographics
NPI:1255449575
Name:DR JAYS FAMILY EYE CARE LLC
Entity type:Organization
Organization Name:DR JAYS FAMILY EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-755-2020
Mailing Address - Street 1:620 MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:IA
Mailing Address - Zip Code:51537-0712
Mailing Address - Country:US
Mailing Address - Phone:712-755-2020
Mailing Address - Fax:712-755-9400
Practice Address - Street 1:620 MARKET STREET
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:IA
Practice Address - Zip Code:51537-0712
Practice Address - Country:US
Practice Address - Phone:712-755-2020
Practice Address - Fax:712-755-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA02008152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0292748Medicaid
IA0292748Medicaid
IAU37059Medicare UPIN
IA1109300002Medicare NSC