Provider Demographics
NPI:1851361968
Name:WALDMAN, ERIC M (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:M
Last Name:WALDMAN
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 1:607 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:PASAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055
Mailing Address - Country:US
Mailing Address - Phone:973-473-3384
Mailing Address - Fax:973-473-0366
Practice Address - Street 1:607 MAIN AVE
Practice Address - Street 2:
Practice Address - City:PASAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055
Practice Address - Country:US
Practice Address - Phone:973-473-3384
Practice Address - Fax:973-473-0366
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJA003524152W00000X
NY3311152W00000X
PA4949152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0530107Medicaid
NJ521374Medicare PIN
U21531Medicare UPIN
NJ0530107Medicaid