Provider Demographics
NPI:1558430728
Name:TEPPER, WAYNE P (OD)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:P
Last Name:TEPPER
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 1:333 PLAZA REAL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-3938
Mailing Address - Country:US
Mailing Address - Phone:561-392-8383
Mailing Address - Fax:561-392-1134
Practice Address - Street 1:333 PLAZA REAL
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-3938
Practice Address - Country:US
Practice Address - Phone:561-392-8383
Practice Address - Fax:561-392-1134
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1118152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV07352Medicare UPIN
FL19244Medicare ID - Type Unspecified