DR. JERRY STANLEY WAKE (NPI# 1013033059) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013033059 |
| Entity Type | Individual |
| Full Name | DR. JERRY STANLEY WAKE |
| Credential | O.D. |
| Practice Address |
1630 W Redondo Beach Blvd Suite #1 Gardena CA 90247-3200 |
| Practice Telephone | 3103248205 |
| Mailing Telephone | 3103248205 |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2014-05-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 5790T | CA | Eye and Vision Services Providers |
| N | 152WC0802X |
Optometrist Specialization: Corneal and Contact Management |
5790T | CA | Eye and Vision Services Providers |
| Street Address |
1630 W REDONDO BEACH BLVD SUITE #1 |
| City | GARDENA |
| State | CA |
| Zip Code | 90247-3200 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619924297 | Meiji Pharmacy Inc | Pharmacy | 1630 W Redondo Beach Blvd, Ste 14, Gardena, CA 90247-3200 | 2006-05-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982204707 | Melissa Reyes | Home Health Aide | 835 N Rosecrans Ave Apt 125, Gardena, CA 90247 | 2020-10-30 |
| 1538645569 | Christopher Jabarie Markham | Case Manager/Care Coordinator | 12817 S Hoover St Apt 14, Gardena, CA 90247 | 2018-07-12 |
| 1013404243 | Sunshine Community Resource Organization Center | Counselor | 1202 W 135th Street, Gardena, CA 90247 | 2018-04-13 |
| 1124537261 | Nina Vu | Pharmacist | 14416 Plum Lane, Unit 3, Gardena, CA 90247 | 2017-09-20 |
| 1356871008 | Delaram Moshfegh | Pharmacist | 1735 Artesia Blvd, Gardena, CA 90247 | 2017-06-15 |
| 1497290522 | Better Vision Optical | Eyewear Supplier (Equipment, not the service) | 1121 W Gardena Blvd Ste A, Gardena, CA 90247 | 2016-12-28 |
| 1013394832 | Lydia Gonzalez | Case Management | 13605 S Vermont Ave Apt 16, Gardena, CA 90247 | 2015-04-30 |
| 1396147682 | Daniel Medical Group, Inc. | Acupuncturist | 2015 W Redondo Beach Blvd., Ste F, Gardena, CA 90247 | 2014-09-18 |
| 1386913663 | Linda Doreen Humphries | Nurse Practitioner | 1141 W. Redondo Beach Blvd., Suite 402, Gardena, CA 90247 | 2011-12-15 |
| 1215229547 | Everett D Wong | Social Worker | 1045 W Redondo Beach Blvd Ste 150, Gardena, CA 90247 | 2011-05-04 |
| Find all providers in zip 90247 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740888627 | Jennifer Ngo | Optometrist | 3217 W 153rd St, Gardena, CA 90249-4011 | 2020-10-13 |
| 1114581881 | Michael Kobayashi, Od Professional Corporation | Optometrist | 18204 S Western Ave, Gardena, CA 90248-3819 | 2019-04-27 |
| 1962955567 | Amy H. Ishigo | Optometrist | 1425 W Artesia Blvd Ste 32, Gardena, CA 90248-3230 | 2016-07-29 |
| 1942611199 | Jerry S. Wake, O.d., Inc. | Optometrist | 1630 W Redondo Beach Blvd Ste 1, Gardena, CA 90247-3200 | 2014-05-09 |
| 1851679716 | Jasmine Ardeshir Hamid | Optometrist | 1141 W Redondo Beach Blvd Ste 101, Gardena, CA 90247-3585 | 2011-07-26 |
| 1457519100 | Almar Vista Inc | Optometrist | 14506 S Crenshaw Blvd, Gardena, CA 90249-3158 | 2008-05-29 |
| 1376685958 | Peter Hoa Nguyen | Optometrist | 14506 Crenshaw Blvd, Gardena, CA 90249-3158 | 2007-02-12 |
| 1386740447 | Joel David Goodman | Optometrist | 1713 W Artesia Blvd., Gardena, CA 90248-3220 | 2006-09-16 |
| 1679678965 | Michael Herman O.d. Inc | Optometrist | 18203 S Western Ave Ste 102, Gardena, CA 90248 | 2006-09-13 |
| 1720052392 | Amy Jo Calder | Optometrist | 1142 W Redondo Beach Blvd, Gardena, CA 90247-3538 | 2006-02-13 |
| Find all providers in GARDENA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.