Provider Demographics
NPI:1285619908
Name:KAY, BARRY M (OD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:M
Last Name:KAY
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 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:2011 HARRISON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-5019
Practice Address - Country:US
Practice Address - Phone:954-923-5367
Practice Address - Fax:954-923-3484
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1660152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078807400Medicaid
FL078807400Medicaid
FL1222670001Medicare NSC
FLT8413Medicare UPIN