=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306227392
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA WAI O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2015
-----------------------------------------------------
Last Update Date | 02/14/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12721 MORENO BEACH DR
-----------------------------------------------------
City | MORENO VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92555-4411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-560-9922
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28130 AUCKLAND CT
-----------------------------------------------------
City | SUN CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92586-2437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-560-9922
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 15214
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------