Provider Demographics
NPI:1932174018
Name:JAY ANANTHAN-NAIR, OD, PA
Entity Type:Organization
Organization Name:JAY ANANTHAN-NAIR, OD, PA
Other - Org Name:DEBARY OPTICAL/SCHMIDT OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANANTHAN-NAIR
Authorized Official - Suffix:
Authorized Official - Credentials:OD, PHD
Authorized Official - Phone:386-668-0600
Mailing Address - Street 1:38 N US HIGHWAY 17/92
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2519
Mailing Address - Country:US
Mailing Address - Phone:386-668-0600
Mailing Address - Fax:
Practice Address - Street 1:38 N US HIGHWAY 17/92
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2519
Practice Address - Country:US
Practice Address - Phone:386-668-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4535880001Medicare ID - Type UnspecifiedOPTICAL MATERIALS