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NPI Code Detail

MEDICARE: DR. EDWARD JOHN WASLOSKI O.D.

MEDICARE: DR. EDWARD JOHN WASLOSKI 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
1152W00000XOptometristOPC2214FL
2152W00000XOptometristTA0943MD

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1K769BH63OTHERMDMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952307084
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWARD JOHN WASLOSKI O.D.
Provider Business Mailing Address
First Line : 101 RIVERFRONT BLVD STE 710
Second Line :
City : BRADENTON
State : FL
Zip : 34205-8812
Country : US
Telephone Number : 941-776-4000
Fax Number : 941-896-8480
Provider Business Practice Location Address
First Line : 1312 MANATEE AVE E
Second Line :
City : BRADENTON
State : FL
Zip : 34208-1358
Country : US
Telephone Number : 941-750-8797
Fax Number : 941-799-2804
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2005
Last Update Date : 10/26/2023

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