Basic Information
| Provider Information | |||||||||
| NPI: | 1104816933 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROFSKY | ||||||||
| FirstName: | JAY | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 725 W. LA VETA AVE | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928684439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147448801 | ||||||||
| FaxNumber: | 7147448630 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 W. LA VETA AVE | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928684439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147448801 | ||||||||
| FaxNumber: | 7147448630 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2005 | ||||||||
| LastUpdateDate: | 07/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPT 10161 T | CA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | SD0101610 | 05 | CA | MEDICAID |