Provider Demographics
NPI:1164415345
Name:WALDMAN, WILLIAM S (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:S
Last Name:WALDMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 E THORNTON PKWY
Mailing Address - Street 2:SUITE 222
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-2100
Mailing Address - Country:US
Mailing Address - Phone:303-920-3937
Mailing Address - Fax:303-452-0065
Practice Address - Street 1:550 E THORNTON PKWY
Practice Address - Street 2:SUITE 222
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2100
Practice Address - Country:US
Practice Address - Phone:303-920-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO794152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COT60743Medicare UPIN
CO802027Medicare ID - Type Unspecified
COCOA108457Medicare UPIN
COC805492Medicare PIN