Provider Demographics
NPI:1750550190
Name:ROBERT A. WAYDA, O.D.
Entity type:Organization
Organization Name:ROBERT A. WAYDA, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:WAYDA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:559-591-1025
Mailing Address - Street 1:204 N K ST
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-1926
Mailing Address - Country:US
Mailing Address - Phone:559-591-1025
Mailing Address - Fax:559-591-9345
Practice Address - Street 1:204 N K ST
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-1926
Practice Address - Country:US
Practice Address - Phone:559-591-1025
Practice Address - Fax:559-591-9345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP580700332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1558360701OtherNPI
CASD0058070Medicaid
CAU25690Medicare UPIN
CASD0058070Medicaid
SD0058070Medicare PIN