Mark Alan Jury, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

9583T Issued in CA

Practice address

23905 Clinton Keith Rd
Suite115
Wildomar, CA 92595-7897

Phone

(951) 304-9733

NPI assigned

Jul 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

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 and National Provider Directory roles.

• Mark a Jury, OD a Optometric Professional Corporation

  • Optometrist
  • Wildomar, CA
  • NPI 1376627000
  NPD (past) Authorized official

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477578458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39708 NICE AVE",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925626704",
            "telephone_number": "951-600-9844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23905 CLINTON KEITH RD",
            "address_2": "SUITE115",
            "city": "WILDOMAR",
            "state": "CA",
            "postal_code": "925957897",
            "telephone_number": "951-304-9733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JURY",
        "first_name": "MARK",
        "middle_name": "ALAN",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "9583T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0095831",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Destinee Jones
• Ramiyah Jones
• Joseph Nevarez MD CWS Inc
• JSP Corporation Inc
• Ernest V Juarez, PAC
• James Kabellis II, MD
• Azzrinna Kadri
• Kaiser Foundation Health Plan Inc
• Nabila Kalu
• Maile L Kamalii, RBT

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.