Provider Demographics
NPI:1669095584
Name:RICHARDS, JAYLA ROSE (OD)
Entity type:Individual
Prefix:DR
First Name:JAYLA
Middle Name:ROSE
Last Name:RICHARDS
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 1:908 HAVER DR
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43526-1046
Mailing Address - Country:US
Mailing Address - Phone:419-786-8503
Mailing Address - Fax:
Practice Address - Street 1:219 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1759
Practice Address - Country:US
Practice Address - Phone:419-636-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.007089152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist