Provider Demographics
NPI:1912971151
Name:ANANTHAN-NAIR, JAYAKUMAR (OD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JAYAKUMAR
Middle Name:
Last Name:ANANTHAN-NAIR
Suffix:
Gender:M
Credentials:OD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4706
Mailing Address - Country:US
Mailing Address - Phone:407-775-7654
Mailing Address - Fax:407-834-6082
Practice Address - Street 1:787 HEALTH CARE DR
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8325
Practice Address - Country:US
Practice Address - Phone:407-339-0303
Practice Address - Fax:407-339-0961
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2940152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593540140OtherVSP
FL20715OtherBCBS
FL51451OtherCVC
FLFL2940OtherEYEMED
FL593540140OtherUNITED HEALTH CARE
FL593540140OtherCOMPBENEFITS/PRIMARY PLUS
FL620194600Medicaid
FL5405512OtherAETNA
FLFL2940OtherEYEMED
FLU59175Medicare UPIN
FL51451OtherCVC
FL51451OtherCVC