Organization
JERRY S. WAKE, O.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY WAKE O.D. (OWNER)
(310) 324-8205
Entity
Organization
Contact information
Practice address
1630 W REDONDO BEACH BLVD STE 1, GARDENA, CA 90247-3200
(310) 324-8205
Mailing address
1630 W REDONDO BEACH BLVD STE 1, GARDENA, CA 90247-3200
(310) 324-8205
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
5790T
CA
152WC0802X
Corneal and Contact Management Optometrist
Primary
5790T
CA
Other
Enumeration date
05/09/2014
Last updated
09/23/2014
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