Basic Information
| Provider Information | |||||||||
| NPI: | 1346223831 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HIGHLAND | ||||||||
| FirstName: | JAY | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 560 | ||||||||
| Address2: | |||||||||
| City: | BAYFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 811220560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708842020 | ||||||||
| FaxNumber: | 9708842977 | ||||||||
| Practice Location | |||||||||
| Address1: | 49 W. MILL ST. | ||||||||
| Address2: | |||||||||
| City: | BAYFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708842020 | ||||||||
| FaxNumber: | 9708842977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2005 | ||||||||
| LastUpdateDate: | 11/28/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPT-874 | CO | N | Eye and Vision Services Providers | Optometrist | 152WC0802X | OPT-874 | CO | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 152WP0200X | OPT-874 | CO | N | Eye and Vision Services Providers | Optometrist | Pediatrics | 152WV0400X | OPT-874 | CO | Y | Eye and Vision Services Providers | Optometrist | Vision Therapy |
No ID Information.