MEDICARE: DR. DAVID L WALDIE 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	1053-3	KS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00624552	OTHER	KS	RR MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	468502	OTHER	KS	CHILDREN'S MERCY/FHP
2	651174	OTHER	KS	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	636280	OTHER	KS	FIRST GUARD
6	000975	OTHER	KS	PREFERRED HEALTH SYSTEMS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982600821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID L WALDIE O.D.

Provider Business Mailing Address
First Line	:	9390 E CENTRAL AVE
Second Line	:	STE 101
City	:	WICHITA
State	:	KS
Zip	:	67206-2555
Country	:	US
Telephone Number	:	316-636-2080
Fax Number	:	316-636-2965

Provider Business Practice Location Address
First Line	:	9390 E CENTRAL AVE
Second Line	:	STE 101
City	:	WICHITA
State	:	KS
Zip	:	67206-2555
Country	:	US
Telephone Number	:	316-636-2080
Fax Number	:	316-636-2965

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	10/28/2008

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Directions to “ DR. DAVID L WALDIE O.D.” Practice Location

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