Jerry S. Wake, O.D., Inc.

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

5790T Issued in CA

Legal business name

JERRY S. WAKE, O.D., INC.

Practice address

1630 W Redondo Beach Blvd Ste 1
Gardena, CA 90247-3200

Phone

(310) 324-8205

NPI assigned

May 9, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Jerry Wake, O.D.

Title

Owner

Phone

(310) 324-8205

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1399593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411430400000",
    "number": "1942611199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1630 W REDONDO BEACH BLVD STE 1",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902473200",
            "telephone_number": "310-324-8205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 W REDONDO BEACH BLVD STE 1",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902473200",
            "telephone_number": "310-324-8205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY S. WAKE, O.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-09",
        "last_updated": "2014-09-23",
        "status": "A",
        "authorized_official_last_name": "WAKE",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-324-8205",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "5790T",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CA",
            "license": "5790T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Jenkins, LMFT
• Janet G Jenson, CAODC
• Caroline Jeong
• Eusun Jeong
• Yong in Jane Jeong
• Halimo M Jeylani, NONE
• Alexandria Jezina
• Sandi Karina Jimenez Adame
• Nathalie Jimenez Gutierrez
• Alejandra Jimenez, OTR/L

• Corneal and Contact Management Optometrist in Gardena, CA
• Providers in Gardena, CA by specialty
• Corneal and Contact Management Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2014; 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.