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General NPI Number Information
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NPI Number | 1750550190
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Entity Type | Organization
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Legal Business Name | ROBERT A. WAYDA, O.D.
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 02/28/2008
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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 | OWNER
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Name | DR. ROBERT A WAYDA
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Credential | O.D.
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Telephone | 559-591-1025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | OP580700
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License Number State | CA
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