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General NPI Number Information
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NPI Number | 1558360701
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Entity Type | Individual
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Provider Name | ROBERT A WAYDA O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 204 N K ST
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City | DINUBA
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State | CA
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Zip | 93618-1926
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Country | US
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Telephone | 559-591-1025
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Fax | 559-591-9345
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Provider Business Mailing Address
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Address Line | 204 N K ST
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City | DINUBA
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State | CA
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Zip | 93618-1926
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Country | US
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Telephone | 559-591-1025
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Fax | 559-591-9345
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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 | 5807 TPA
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License Number State | CA
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