Jeffry Wu O.D. Professional Corporation

Primary specialty

OptometristTaxonomy code 152W00000X

License

15020 Issued in CA

Legal business name

JEFFRY WU O.D. PROFESSIONAL CORPORATION

Doing business as

State Street Optometry

Practice address

112 E State St
Redlands, CA 92373-4756

Phone

(909) 792-2280

Fax

(909) 792-4872

NPI assigned

Nov 15, 2017

Last updated

Jul 20, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jeffry Wu, ODNPI 1679989339

Title

President

Phone

(909) 792-2280

Specialties & licenses 4

Addresses

Other names 1

• State Street Optometry Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

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.

• Jeffry Wu, O.D.

  • Optometrist
  • Redlands, CA
  • NPI 1679989339
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1510704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595203200000",
    "number": "1720591480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 E STATE ST",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923734756",
            "telephone_number": "909-792-2280",
            "fax_number": "909-792-4872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 E STATE ST",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923734756",
            "telephone_number": "909-792-2280",
            "fax_number": "909-792-4872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFRY WU O.D. PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-15",
        "last_updated": "2020-07-20",
        "certification_date": "2020-07-20",
        "status": "A",
        "authorized_official_last_name": "WU",
        "authorized_official_first_name": "JEFFRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-792-2280",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "15020",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CA",
            "license": "15020",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "CA",
            "license": "15020",
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "",
            "desc": "Optometrist, Occupational Vision",
            "state": "CA",
            "license": "15020",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "State Street Optometry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jeanpaulo Alfonso Gonzalez
• Azadeh Jebelli
• Jeffrey S. Paxman, DDS, a Professional Corporation
• James William Jeffries
• Sharen Knudsen Jeffries, M.D.
• Monica Jenkins, MSN, FNP-C
• Jennifer Cobanov, MD Professional Corporation (My Pediatric Home)
• Jennifer Hayhurst Physician Assistant Apc (Radiant Dermatology)
• Michelle Jensen
• Dongjun Jeong, D.D.S

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.