NPIMap

Organization Active NPI

Mark a Jury, OD a Optometric Professional Corporation

  • Optometrist
  • Wildomar, CA
National Provider Identifier
1376627000
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT9583 Issued in CA
Legal business name
MARK A JURY, OD A OPTOMETRIC PROFESSIONAL CORPORATION
Practice address
23905 Clinton Keith Rd
Ste #115
Wildomar, CA 92595-7897
Phone
(951) 304-9733
Fax
(866) 741-5945
NPI assigned
Oct 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mark A Jury, ODNPI 1477578458
Title
Optometrist
Phone
(951) 304-9733

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OPT9583 CA Primary

Addresses

Primary practice location

23905 Clinton Keith Rd
Ste #115
Wildomar, CA 92595-7897

Mailing address

23905 Clinton Keith Rd
Ste #115
Wildomar, CA 92595-7897
Phone (951) 304-9733

Other identifiers 1

IdentifierTypeStateIssuer
SD0095831MedicaidCA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376627000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23905 CLINTON KEITH RD",
            "address_2": "STE #115",
            "city": "WILDOMAR",
            "state": "CA",
            "postal_code": "925957897",
            "telephone_number": "951-304-9733",
            "fax_number": "866-741-5945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23905 CLINTON KEITH RD",
            "address_2": "STE #115",
            "city": "WILDOMAR",
            "state": "CA",
            "postal_code": "925957897",
            "telephone_number": "951-304-9733",
            "fax_number": "866-741-5945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK A JURY, OD A OPTOMETRIC PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JURY",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "951-304-9733",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT9583",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0095831",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wildomar, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.