NPIMap

Organization Active NPI

Jeffrey P Wasserstrom MD a Medical Corporation

  • Ophthalmology Physician
  • La Mesa, CA
National Provider Identifier
1225304108
Registry record updated Apr 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
G54813 Issued in CA
Legal business name
JEFFREY P WASSERSTROM MD A MEDICAL CORPORATION
Practice address
5565 Grossmont Center Dr
BLDG 3 Suite 551
La Mesa, CA 91942-3020
Phone
(619) 698-1088
Fax
(619) 698-1189
NPI assigned
Mar 26, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2012

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

Authorized official

Name
Dr. Jeffrey P Wasserstrom, MDNPI 1710922687
Title
President
Phone
(619) 698-1088

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X G54813 CA Primary

Addresses

Primary practice location

5565 Grossmont Center Dr
BLDG 3 Suite 551
La Mesa, CA 91942-3020

Mailing address

5565 Grossmont Center Dr
BLDG 3 Suite 551
La Mesa, CA 91942-3020
Phone (619) 698-1088

National Provider Directory

National Provider Directory

Locations

5565 Grossmont Center Dr
#5
La Mesa, CA 91942
Phone (619) 698-1088

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1332720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334016000000",
    "number": "1225304108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5565 GROSSMONT CENTER DR",
            "address_2": "BLDG 3 SUITE 551",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919423020",
            "telephone_number": "619-698-1088",
            "fax_number": "619-698-1189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5565 GROSSMONT CENTER DR",
            "address_2": "BLDG 3 SUITE 551",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919423020",
            "telephone_number": "619-698-1088",
            "fax_number": "619-698-1189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY P WASSERSTROM MD A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-26",
        "last_updated": "2012-04-10",
        "status": "A",
        "authorized_official_last_name": "WASSERSTROM",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-698-1088",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "G54813",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2012; 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.