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
111 RALEY BLVD, #240, CHICO, CA 95928-8351
(530) 892-2020
(530) 898-9614
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
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ41345Z
BLUE SHIELD
CA
Enumeration date
07/22/2006
Last updated
10/17/2007
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