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Organization
JEROME WH NISWONGER MD INC
Active
Organization
JEROME WH NISWONGER MD INC
Active
Other names
EYE LIFE INSTITUTE
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEROME WH NISWONGER MD (OWNER/PRESIDENT)
(530) 877-2020
Entity
Organization
Contact information
Practice address
6283 CLARK RD, #10, PARADISE, CA 95969-4100
(530) 877-2020
(530) 877-4641
Mailing address
6283 CLARK RD, #10, PARADISE, CA 95969-4100
(530) 877-2020
(530) 877-4641
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
207W00000X
Ophthalmology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ22165Z
BLUE CROSS
CA
Enumeration date
07/22/2006
Last updated
09/11/2025
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