Provider Demographics
NPI:1710510078
Name:PATRICIA WAI OD INC
Entity Type:Organization
Organization Name:PATRICIA WAI OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-560-9922
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-14
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty