1750495115 NPI number — DR. JUANITA DAY O.D.

Table of content: DR. JUANITA DAY O.D. (NPI 1750495115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750495115 NPI number — DR. JUANITA DAY O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAY
Provider First Name:
JUANITA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750495115
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 181677
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76096-1677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-453-6329
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7111 MARVIN D LOVE FWY
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75237-3112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-453-6329
Provider Business Practice Location Address Fax Number:
682-651-5559
Provider Enumeration Date:
08/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3565T , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0932725-03 . This is a "CHILDREN WITH SPECIAL HEALTH CARE NEEDS (CSHCN)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TXB125427 . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 75-2225993 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 40877 . This is a "AVESIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0932725-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 918245 . This is a "EYEMED VISION CARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 910465 . This is a "BLOCK VISION OF TEXAS,INC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0065FF . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 50497 . This is a "AVESIS" identifier . This identifiers is of the category "OTHER".




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