Provider Demographics
NPI:1972649697
Name:WOLBERT, JAMEY P (OD)
Entity type:Individual
Prefix:DR
First Name:JAMEY
Middle Name:P
Last Name:WOLBERT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17230 AUTRY POND RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-2097
Mailing Address - Country:US
Mailing Address - Phone:210-307-4749
Mailing Address - Fax:
Practice Address - Street 1:17230 AUTRY POND RD STE 104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-2097
Practice Address - Country:US
Practice Address - Phone:210-307-4749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004265152W00000X
SC1546152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCB0927Medicare PIN