Provider Demographics
NPI:1104362680
Name:WALDRON EYECARE
Entity Type:Organization
Organization Name:WALDRON EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREEN
Authorized Official - Middle Name:GODDARD
Authorized Official - Last Name:WALDRON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-253-7901
Mailing Address - Street 1:PO BOX 6653
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5227
Mailing Address - Country:US
Mailing Address - Phone:757-253-7901
Mailing Address - Fax:757-253-7928
Practice Address - Street 1:4630 MONTICELLO AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-8200
Practice Address - Country:US
Practice Address - Phone:757-253-7901
Practice Address - Fax:757-253-7928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001279152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty