Provider Demographics
NPI:1609884295
Name:WAYNE, DEBORAH L (OD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:L
Last Name:WAYNE
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 1:12 RANDELL RD
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-3125
Mailing Address - Country:US
Mailing Address - Phone:781-231-2242
Mailing Address - Fax:
Practice Address - Street 1:380 BROADWAY
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-2871
Practice Address - Country:US
Practice Address - Phone:617-884-1222
Practice Address - Fax:617-884-2283
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3063152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0082980OtherUNITED HEALTH
MA0349208Medicaid
MA7645OtherDAVIS VISION-MAL
MA993799OtherNETWORK HEALTH
MAAA2031OtherHP-CHELSEA
MAAA2032OtherHP-MALDEN
MA0006203OtherNHP
MA112343OtherEYEMED
MA7646OtherDAVIS VISION CHEL
MA725464OtherTUFTS
MADW13954OtherSPECTERA
MAW15616OtherBLUE CROSS BLUE SHIELD
MA993799OtherNETWORK HEALTH
MA0349208Medicaid