Provider Demographics
NPI:1013980051
Name:WADDINGHAM-URBAITIS AND ASSOCIATES PC
Entity Type:Organization
Organization Name:WADDINGHAM-URBAITIS AND ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WADDINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:563-355-4716
Mailing Address - Street 1:3625 UTICA RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1646
Mailing Address - Country:US
Mailing Address - Phone:563-355-4716
Mailing Address - Fax:
Practice Address - Street 1:3625 UTICA RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1646
Practice Address - Country:US
Practice Address - Phone:563-355-4716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA780925OtherCLARITY GROUP WUA
IAI7999Medicare PIN
IA780925OtherCLARITY GROUP WUA