Healthcare Provider Details

I. General information

NPI: 1326076506
Provider Name (Legal Business Name): RICHARD THUE WACKER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MIRANDA AVE VAPAHCS OPTOM/112
PALO ALTO CA
94304-1207
US

IV. Provider business mailing address

3801 MIRANDA AVE VAPAHCS OPTOM/112
PALO ALTO CA
94304-1207
US

V. Phone/Fax

Practice location:
  • Phone: 650-493-5000
  • Fax: 650-852-3228
Mailing address:
  • Phone: 650-493-5000
  • Fax: 650-852-3228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8134T
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number8134T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: