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General NPI Number Information
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NPI Number | 1518132729
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Entity Type | Organization
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Legal Business Name | JOSEPH S WALD ENTERPRISES INC
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 09/22/2015
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Provider Practice Location Address
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Address Line | 855 S ALDER ST SUITE A
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City | BURLINGTON
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State | WA
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Zip | 98233-1819
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Country | US
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Telephone | 360-755-9211
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Fax | 360-755-0501
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Provider Business Mailing Address
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Address Line | 855 S ALDER ST SUITE A
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City | BURLINGTON
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State | WA
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Zip | 98233-2808
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Country | US
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Telephone | 360-755-9211
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Fax | 360-755-0501
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH S WALD
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Credential | OD
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Telephone | 360-755-9211
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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 | 3634
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License Number State | WA
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