1750550190 NPI number — ROBERT A. WAYDA, O.D.

Table of content: (NPI 1750550190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750550190 NPI number — ROBERT A. WAYDA, O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT A. WAYDA, O.D.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750550190
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
204 N K ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DINUBA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93618-1926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-591-1025
Provider Business Mailing Address Fax Number:
559-591-9345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 N K ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DINUBA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93618-1926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-591-1025
Provider Business Practice Location Address Fax Number:
559-591-9345
Provider Enumeration Date:
02/28/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WAYDA
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
559-591-1025

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  OP580700 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1558360701 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: SD0058070 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".