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General NPI Number Information
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NPI Number | 1013980051
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Entity Type | Organization
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Legal Business Name | WADDINGHAM-URBAITIS AND ASSOCIATES PC
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 03/30/2009
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Provider Practice Location Address
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Address Line | 3625 UTICA RIDGE ROAD
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City | BETTENDORF
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State | IA
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Zip | 52722-1646
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Country | US
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Telephone | 563-355-4716
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Fax |
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Provider Business Mailing Address
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Address Line | 3625 UTICA RIDGE ROAD
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City | BETTENDORF
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State | IA
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Zip | 52722-1646
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Country | US
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Telephone | 563-355-4716
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DEBORAH A. WADDINGHAM
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Credential | OD
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Telephone | 563-355-4716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2000
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License Number State | IA
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