Provider Demographics
NPI:1851303911
Name:WAIGANDT, MARTI GAYE (OD)
Entity Type:Individual
Prefix:DR
First Name:MARTI
Middle Name:GAYE
Last Name:WAIGANDT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:5004 INNSBRUCK WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6377
Mailing Address - Country:US
Mailing Address - Phone:573-874-3937
Mailing Address - Fax:573-874-4180
Practice Address - Street 1:3901 S PROVIDENCE RD
Practice Address - Street 2:B
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-7174
Practice Address - Country:US
Practice Address - Phone:573-874-3937
Practice Address - Fax:573-874-4180
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02751152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist