1609884295 NPI number — DR. DEBORAH L WAYNE O.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609884295 NPI number — DR. DEBORAH L WAYNE O.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

WAYNE

Provider First Name:

DEBORAH

Provider Middle Name:

L

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

O.D.

Provider Gender Code:

F

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:

1609884295

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

12 RANDELL RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SAUGUS

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

01906-3125

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

781-231-2242

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

380 BROADWAY

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

CHELSEA

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

02150-2871

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

617-884-1222

Provider Business Practice Location Address Fax Number:

617-884-2283

Provider Enumeration Date:

08/03/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 152W00000X , with the licence number:  3063 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0082980 . This is a "UNITED HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 0349208 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 7645 . This is a "DAVIS VISION-MAL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 993799 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: AA2031 . This is a "HP-CHELSEA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: AA2032 . This is a "HP-MALDEN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 0006203 . This is a "NHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 112343 . This is a "EYEMED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 7646 . This is a "DAVIS VISION CHEL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 725464 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: DW13954 . This is a "SPECTERA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: W15616 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".