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General NPI Number Information
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NPI Number | 1285781922
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Entity Type | Individual
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Provider Name | EUGENE L WAKE O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1689 ARDEN WAY
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City | SACRAMENTO
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State | CA
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Zip | 95815-4030
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Country | US
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Telephone | 916-648-0222
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Fax |
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Provider Business Mailing Address
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Address Line | 1620 SARATOGA AVE # P-301 WESTGATE S C
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City | SAN JOSE
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State | CA
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Zip | 95129-5113
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Country | US
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Telephone | 408-371-5180
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Fax | 408-371-5154
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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 | 6829
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License Number State | CA
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