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General NPI Number Information
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NPI Number | 1528210531
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Entity Type | Organization
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Legal Business Name | WAYNE C. SCHRADER, OPTOMETRIST, INC.
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 1109 KENNEDY PL SUITE 1
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City | DAVIS
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State | CA
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Zip | 95616-1271
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Country | US
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Telephone | 530-756-2481
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Fax | 530-756-3548
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Provider Business Mailing Address
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Address Line | 1109 KENNEDY PL SUITE 1
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City | DAVIS
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State | CA
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Zip | 95616-1271
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Country | US
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Telephone | 530-756-2481
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Fax | 530-756-3548
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WAYNE C SCHRADER
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Credential | O.D.
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Telephone | 530-756-2481
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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 | 5769
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License Number State | CA
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