Provider Demographics
NPI:1871555920
Name:MERTEN, JAY LEONARD (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:LEONARD
Last Name:MERTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7179 DRUMMOND DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-8639
Mailing Address - Country:US
Mailing Address - Phone:214-418-3773
Mailing Address - Fax:
Practice Address - Street 1:7179 DRUMMOND DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-8639
Practice Address - Country:US
Practice Address - Phone:214-418-3773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5853207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B24871Medicare UPIN
TX833563Medicare ID - Type Unspecified