MEDICARE: DR. FRED M WALDMAN 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	152W00000X	Optometrist	OPT886	CO

General Provider Information

NPI Number	:	1750434775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRED M WALDMAN O.D

Provider Business Mailing Address
First Line	:	8929 E JEWELL CIR
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-3471
Country	:	US
Telephone Number	:	303-750-6449
Fax Number	:	303-750-0509

Provider Business Practice Location Address
First Line	:	4301 E VIRGINIA AVE
Second Line	:
City	:	GLENDALE
State	:	CO
Zip	:	80246-1510
Country	:	US
Telephone Number	:	303-209-0185
Fax Number	:	303-209-0187

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

Provider Enumeration Date	:	01/21/2007
Last Update Date	:	07/08/2007

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