Provider Demographics
NPI:1750434775
Name:WALDMAN, FRED M (OD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:M
Last Name:WALDMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:FRED
Other - Middle Name:M
Other - Last Name:WALDMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:8929 E JEWELL CIR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-3471
Mailing Address - Country:US
Mailing Address - Phone:303-750-6449
Mailing Address - Fax:303-750-0509
Practice Address - Street 1:4301 E VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-1510
Practice Address - Country:US
Practice Address - Phone:303-209-0185
Practice Address - Fax:303-209-0187
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT886152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist