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General NPI Number Information
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NPI Number | 1144375742
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Entity Type | Individual
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Provider Name | ROBERT WALDMAN O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 05/01/2012
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Provider Practice Location Address
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Address Line | 8900 MENTOR AVE SUITE B
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City | MENTOR
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State | OH
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Zip | 44060-7304
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Country | US
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Telephone | 440-255-7727
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Fax |
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Provider Business Mailing Address
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Address Line | 8030 AILEEN DR
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City | MENTOR
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State | OH
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Zip | 44060-7304
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Country | US
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Telephone | 440-255-6039
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 3382T1193
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License Number State | OH
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