Provider Demographics
NPI:1881721660
Name:WAHBA, DAVID E, (LDO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E,
Last Name:WAHBA
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:WAHBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LDO
Mailing Address - Street 1:13894 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3210
Mailing Address - Country:US
Mailing Address - Phone:216-932-3937
Mailing Address - Fax:216-371-0799
Practice Address - Street 1:13894 CEDAR RD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3210
Practice Address - Country:US
Practice Address - Phone:216-932-3937
Practice Address - Fax:216-371-0799
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSC.3694156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician