Provider Demographics
NPI:1306227392
Name:WAI, PATRICIA (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:WAI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28130 AUCKLAND CT
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2437
Mailing Address - Country:US
Mailing Address - Phone:626-560-9922
Mailing Address - Fax:
Practice Address - Street 1:12721 MORENO BEACH DR
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-4411
Practice Address - Country:US
Practice Address - Phone:626-560-9922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15214152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist