Provider Demographics
NPI:1750526091
Name:VAIDHYAN, JESSY JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:JESSY
Middle Name:JAMES
Last Name:VAIDHYAN
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 1:114 HILLWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3120
Mailing Address - Country:US
Mailing Address - Phone:617-512-0566
Mailing Address - Fax:
Practice Address - Street 1:50 E 42ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5405
Practice Address - Country:US
Practice Address - Phone:212-697-1838
Practice Address - Fax:212-697-0323
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4704152W00000X
NYTUV007380-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist