Individual provider Active NPI

Jamey P Wolbert, O.D.

  • Optometrist
  • San Antonio, TX
National Provider Identifier
1972649697
Registry record updated Sep 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1546 Issued in SC
Practice address
17230 Autry Pond Rd Ste 104
San Antonio, TX 78247-2097
Phone
(210) 307-4749
NPI assigned
Jan 29, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4901004265 MI
Optometrist 152W00000X 1546 SC Primary

Addresses

Primary practice location

17230 Autry Pond Rd Ste 104
San Antonio, TX 78247-2097

Mailing address

17230 Autry Pond Rd Ste 104
San Antonio, TX 78247-2097
Phone (210) 307-4749

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20251122000107 DC Practitioner - Optometry 6800942194 Reassigns benefits to 1 organization
I20260120001234 VA Practitioner - Optometry 6800942194 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

19100 Ridgewood Pkwy
San Antonio, TX 78259-1828

19100 Ridgewood Pkwy
BLDG 1 7TH Floor
San Antonio, TX 78259-0001

8206 Cherry Ridge Rd
Fairfax Station, VA 22039-3011

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9927TXMDAddiction (Substance Use Disorder) Counselor
4901004265MIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Daniel Poth, O.D. and Associates, P.C. Optometrist CurrentSince Nov 10, 2025 Accepting new patients
Daniel Poth, O.D. and Associates, P.C. Optometrist CurrentSince Nov 10, 2025 Accepting new patients

Locations

11130L South Lakes Dr
Reston, VA 20191
Phone (703) 471-1012

2700 Potomac Mills Cir
Ste 105
Woodbridge, VA 22192
Phone (703) 494-0660

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664236800000",
    "number": "1972649697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17230 AUTRY POND RD STE 104",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782472097",
            "telephone_number": "210-307-4749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17230 AUTRY POND RD STE 104",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782472097",
            "telephone_number": "210-307-4749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLBERT",
        "first_name": "JAMEY",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-29",
        "last_updated": "2022-09-27",
        "certification_date": "2022-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004265",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.