Provider Demographics
NPI:1679636310
Name:WASSEL, JEROLD M (OD)
Entity Type:Individual
Prefix:DR
First Name:JEROLD
Middle Name:M
Last Name:WASSEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3718 NORRISVILLE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:JARRETTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21084-1419
Mailing Address - Country:US
Mailing Address - Phone:410-557-8800
Mailing Address - Fax:410-557-2811
Practice Address - Street 1:3718 NORRISVILLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:JARRETTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21084-1419
Practice Address - Country:US
Practice Address - Phone:410-557-8800
Practice Address - Fax:410-557-2811
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDTA0769152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT59947Medicare UPIN
MDX355Medicare ID - Type Unspecified