Provider Demographics
NPI:1104816933
Name:ROFSKY, JAY E (OD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:E
Last Name:ROFSKY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 W. LA VETA AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4439
Mailing Address - Country:US
Mailing Address - Phone:714-744-8801
Mailing Address - Fax:714-744-8630
Practice Address - Street 1:725 W. LA VETA AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4439
Practice Address - Country:US
Practice Address - Phone:714-744-8801
Practice Address - Fax:714-744-8630
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 10161 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0101610Medicaid
U49686Medicare UPIN
CAOP10161Medicare ID - Type Unspecified