MEDICARE: DR. DEBORAH MARIE WADDINGTON O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WP0200X	Pediatric Optometrist	1332	SC
2	152WV0400X	Vision Therapy Optometrist	1332	SC
3	152W00000X	Optometrist	OPT002191	GA
4	152W00000X	Optometrist	1332	SC
5	152W00000X	Optometrist	TA2441	MD
6	152WC0802X	Corneal and Contact Management Optometrist	1332	SC

General Provider Information

NPI Number	:	1679541700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH MARIE WADDINGTON O.D.

Provider Business Mailing Address
First Line	:	PO BOX 207173
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-7173
Country	:	US
Telephone Number	:	636-200-4393
Fax Number	:	636-527-0766

Provider Business Practice Location Address
First Line	:	1105 CHARLES TOWNE SQ
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-5705
Country	:	US
Telephone Number	:	843-384-3762
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	07/14/2022

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