Healthcare Provider Details

I. General information

NPI: 1932109410
Provider Name (Legal Business Name): WAYNE CHARLES SCHRADER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 KENNEDY PL SUITE 1
DAVIS CA
95616-1271
US

IV. Provider business mailing address

1109 KENNEDY PL SUITE 1
DAVIS CA
95616-1271
US

V. Phone/Fax

Practice location:
  • Phone: 530-756-2481
  • Fax: 530-756-3548
Mailing address:
  • Phone: 530-756-2481
  • Fax: 530-756-3548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5769T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: