Jerry Stanley Wake, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

5790T Issued in CA

Practice address

1630 W Redondo Beach Blvd
Suite #1
Gardena, CA 90247-3200

Phone

(310) 324-8205

NPI assigned

Mar 21, 2007

Last updated

May 2, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jerry S. Wake, O.D., Inc.

  • Corneal and Contact Management Optometrist
  • Gardena, CA
  • NPI 1942611199
  Authorized official Same address or phone
• Summer McGeever OD Inc

  dba Local Eyes Optometry

  • Optometrist
  • Gardena, CA
  • NPI 1376479675
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398988800000",
    "number": "1013033059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1630 W REDONDO BEACH BLVD",
            "address_2": "SUITE #1",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902473200",
            "telephone_number": "310-324-8205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 W REDONDO BEACH BLVD",
            "address_2": "SUITE #1",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902473200",
            "telephone_number": "310-324-8205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAKE",
        "first_name": "JERRY",
        "middle_name": "STANLEY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-21",
        "last_updated": "2014-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "5790T",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CA",
            "license": "5790T",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vinh Vuong, PHARM.D.
• W. Al-Fadly, M.D., Inc
• Konomi Wada
• Darrius L Wade
• Amanda Wagenbach, LCSW
• Layne Seichi Wakuta
• Nicole Elise Waldschmidt, NONE
• Walgreen Co (Walgreens #07175)
• Mattea Walker Sete
• Darlene M Walker, PSY D

• Optometrist in Gardena, CA
• Providers in Gardena, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.