Jon Gordon Wada, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

9115T Issued in CA

Practice address

2405 Forest Ave
San Jose, CA 95128-1500

Phone

(408) 243-7916

Fax

(408) 243-3525

NPI assigned

Jun 6, 2006

Sex

Male

Sole proprietor

Yes

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

Specialty

Optometry

Education

University of California - School of Optometry, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Practitioners 1

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

• Debbi K. Fan, O.D.

  • Optometrist
  • San Jose, CA
  • NPI 1558375592
  Medicare reassignment

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.

• Jon G. Wada, O.D.

  • Optometrist
  • San Jose, CA
  • NPI 1902967516
  NPD (past) Authorized official
• Vista Center for the Blind and Visually Impaired

  • Low Vision Rehabilitation Optometrist
  • Santa Cruz, CA
  • NPI 1255388765
  NPD (past)
• Vista Center for the Blind and Visually Impaired

  • Low Vision Rehabilitation Optometrist
  • Palo Alto, CA
  • NPI 1447804844
  NPD (past)

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431648000000",
    "number": "1881633501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2405 FOREST AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951281500",
            "telephone_number": "408-243-7916",
            "fax_number": "408-243-3525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2405 FOREST AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951281500",
            "telephone_number": "408-243-7916",
            "fax_number": "408-243-3525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADA",
        "first_name": "JON",
        "middle_name": "GORDON",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2015-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "9115T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0091150",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vyronis Diagnostics Lab LLC
• W Gordon Walker, MD
• Valerie Waagen, MFT
• Deborah S Wachs, M.D.
• Audrey Serena Wack
• Nikita Wadagbalkar
• Mariann Elisha Waddel, ACSW, MSW
• Amanda Waddell, F.N.P.
• Barry Lee Waddell, MD
• Scott Waddell, D.C.

• Optometrist in San Jose, CA
• Providers in San Jose, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.