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General NPI Number Information
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NPI Number | 1710510078
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Entity Type | Organization
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Legal Business Name | PATRICIA WAI OD INC
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Dates
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Enumeration Date | 02/14/2020
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Last Update Date | 09/25/2020
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Provider Practice Location Address
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Address Line | 12721 MORENO BEACH DR
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City | MORENO VALLEY
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State | CA
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Zip | 92555-4411
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Country | US
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Telephone | 626-560-9922
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Fax |
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Provider Business Mailing Address
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Address Line | 28130 AUCKLAND CT
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City | SUN CITY
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State | CA
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Zip | 92586-2437
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Country | US
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Telephone | 626-560-9922
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/CEO
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Name | PATRICIA WAI
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Credential | OD
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Telephone | 626-560-9922
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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 |
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License Number State |
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