1912971151 NPI number — DR. JAYAKUMAR ANANTHAN-NAIR OD, PHD

Table of content: DR. JAYAKUMAR ANANTHAN-NAIR OD, PHD (NPI 1912971151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912971151 NPI number — DR. JAYAKUMAR ANANTHAN-NAIR OD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANANTHAN-NAIR
Provider First Name:
JAYAKUMAR
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD, PHD
Provider Gender Code:
M

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:
1912971151
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 BOSTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTAMONTE SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32701-4706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-775-7654
Provider Business Mailing Address Fax Number:
407-834-6082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
787 HEALTH CARE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32763-8325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-339-0303
Provider Business Practice Location Address Fax Number:
407-339-0961
Provider Enumeration Date:
02/15/2006

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:  OPC2940 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 593540140 . This is a "VSP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 20715 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 51451 . This is a "CVC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: FL2940 . This is a "EYEMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 593540140 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 593540140 . This is a "COMPBENEFITS/PRIMARY PLUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 620194600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5405512 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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