Provider Demographics
NPI:1639886310
Name:WASKIEWICZ, TANIA MOJTEHEDI (OD)
Entity type:Individual
Prefix:DR
First Name:TANIA
Middle Name:MOJTEHEDI
Last Name:WASKIEWICZ
Suffix:
Gender:
Credentials:OD
Other - Prefix:DR
Other - First Name:TANIA
Other - Middle Name:
Other - Last Name:MOJTEHEDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1755 HACIENDA DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-4546
Mailing Address - Country:US
Mailing Address - Phone:760-631-0654
Mailing Address - Fax:760-631-0621
Practice Address - Street 1:1755 HACIENDA DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-4546
Practice Address - Country:US
Practice Address - Phone:760-631-0654
Practice Address - Fax:760-631-0621
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT35295-TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist