Provider Demographics
NPI:1558360701
Name:WAYDA, ROBERT A (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:WAYDA
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 1:204 N K ST
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-1926
Mailing Address - Country:US
Mailing Address - Phone:559-591-1025
Mailing Address - Fax:559-591-9345
Practice Address - Street 1:204 N K ST
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-1926
Practice Address - Country:US
Practice Address - Phone:559-591-1025
Practice Address - Fax:559-591-9345
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5807 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0058070Medicaid
CA0184390001Medicare NSC
CAU25690Medicare UPIN
CASD0058070Medicaid