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General NPI Number Information
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NPI Number | 1235263161
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Entity Type | Organization
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Legal Business Name | DAVID L WALDIE OPTOMETRY
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 10/31/2008
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Provider Practice Location Address
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Address Line | 2230 N RIDGE RD SUITE E
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City | WICHITA
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State | KS
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Zip | 67205-1053
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Country | US
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Telephone | 316-729-8900
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Fax | 316-729-9824
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Provider Business Mailing Address
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Address Line | 2230 N RIDGE RD SUITE E
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City | WICHITA
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State | KS
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Zip | 67205-1053
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Country | US
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Telephone | 316-729-8900
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Fax | 316-729-9824
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Authorized Official
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Title or Position | OWNER
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Name | DAVID L WALDIE
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Credential | OD
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Telephone | 316-729-8900
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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 | 10533
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1659
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License Number State | KS
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