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General NPI Number Information
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NPI Number | 1851574958
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Entity Type | Organization
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Legal Business Name | DR. ALISSA WALD AND ASSOCIATES OPTOMETRY, INC.
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 02/22/2020
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Provider Practice Location Address
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Address Line | 1545 ADAMS AVE SUITE 100
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City | COSTA MESA
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State | CA
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Zip | 92626-3814
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Country | US
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Telephone | 714-545-9162
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Fax | 714-241-1345
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Provider Business Mailing Address
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Address Line | 1545 ADAMS AVE SUITE 100
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City | COSTA MESA
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State | CA
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Zip | 92626-3814
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Country | US
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Telephone | 714-545-9162
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Fax | 714-241-1345
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALISSA WALD
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Credential | O.D.
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Telephone | 714-545-9162
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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 | OPT9377
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License Number State | CA
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