NPIMap

Organization Active NPI

Jon G. Wada, O.D.

  • Optometrist
  • San Jose, CA
National Provider Identifier
1902967516
Registry record updated May 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
9115 Issued in CA
Legal business name
JON G. WADA, O.D.
Practice address
2405 Forest Ave
San Jose, CA 95128-1500
Phone
(408) 243-7916
Fax
(408) 243-3525
NPI assigned
Dec 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2015

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

Authorized official

Name
Jon Gordon Wada, O.D.NPI 1881633501
Title
Owner
Phone
(408) 243-7916

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 9115 CA Primary
Corneal and Contact Management OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WC0802X 9115 CA
Low Vision Rehabilitation OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WL0500X 9115 CA

Addresses

Primary practice location

2405 Forest Ave
San Jose, CA 95128-1500

Mailing address

2405 Forest Ave
San Jose, CA 95128-1500
Phone (408) 243-7916

Other identifiers 1

IdentifierTypeStateIssuer
SD0091150MedicaidCA

National Provider Directory

National Provider Directory

Locations

2405 Forest Ave
San Jose, CA 95128
Phone (408) 243-7915

Practitioners & affiliated clinicians

Practitioners 3

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": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431648000000",
    "number": "1902967516",
    "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": {
        "organization_name": "JON G. WADA, O.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2015-05-15",
        "status": "A",
        "authorized_official_last_name": "WADA",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "GORDON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "408-243-7916",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "9115",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CA",
            "license": "9115",
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "CA",
            "license": "9115",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0091150",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.