Dr. Jerry Stanley Wake
Optometrist Optomitrist - Corneal and Contact Lenses
1630 W Redondo Beach Blvd Suite #1
Gardena
, California 90247-3200
Dr. Jerry Stanley Wake
Optometrist Optomitrist - Corneal and Contact Lenses
1630 W Redondo Beach Blvd Suite #1
Gardena
, California 90247-3200
(310) 324-8205
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About
Features
Specialties
- Optometrist
- Optomitrist - Corneal and Contact Lenses
Languages spoken
- English
Location
First Address
- Dr. Jerry Stanley Wake
- 1630 W Redondo Beach Blvd Suite #1
- Gardena, CA
- Zip : 90247-3200
- Phone : (310) 324-8205
Second Address
- Dr. Jerry Stanley Wake
- 1630 W Redondo Beach Blvd Suite #1
- Gardena, CA
- Zip : 90247-3200
- Phone : (310) 324-8205
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 5790T | CA |
| N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 5790T | CA |
National Provider Identifier
| NPI | 1013033059 |
|---|---|
| Provider Name | Dr. Jerry Stanley Wake |
| First Address | Gardena, CA 90247-3200 |
| Second Address | Gardena, CA 90247-3200 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 21/03/2007 |
| Last Update Date | 02/05/2014 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| U61000 | (02) | CA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.