Basic Information
| Provider Information | |||||||||
| NPI: | 1720205917 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAI | ||||||||
| FirstName: | JERRY | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2350 W. EL CAMINO REAL | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | MOUNTAIN VIEW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940406203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4087396000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 323 N MATHILDA AVE | ||||||||
| Address2: | |||||||||
| City: | SUNNYVALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940854207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4085245900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2007 | ||||||||
| LastUpdateDate: | 05/07/2015 | ||||||||
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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 | 174400000X | 254081-1 | NY | N | Other Service Providers | Specialist | 174400000X | 047915 | CT | N | Other Service Providers | Specialist | 207W00000X | 254081 | NY | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 047915 | CT | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | C134763 | CA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.