Provider Demographics
NPI:1952401085
Name:WAITE, JARAD M (OD PA)
Entity Type:Individual
Prefix:MR
First Name:JARAD
Middle Name:M
Last Name:WAITE
Suffix:
Gender:M
Credentials:OD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 NW 15TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:KS
Mailing Address - Zip Code:67410-1579
Mailing Address - Country:US
Mailing Address - Phone:785-263-2020
Mailing Address - Fax:785-263-1290
Practice Address - Street 1:311 NW 3RD ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:KS
Practice Address - Zip Code:67410
Practice Address - Country:US
Practice Address - Phone:785-263-2020
Practice Address - Fax:785-263-1290
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1667152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1952401085OtherNPI
KS6161060001Medicare NSC