Provider Demographics
NPI:1982600821
Name:WALDIE, DAVID L (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:WALDIE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9390 E CENTRAL AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2555
Mailing Address - Country:US
Mailing Address - Phone:316-636-2080
Mailing Address - Fax:316-636-2965
Practice Address - Street 1:9390 E CENTRAL AVE
Practice Address - Street 2:STE 101
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2555
Practice Address - Country:US
Practice Address - Phone:316-636-2080
Practice Address - Fax:316-636-2965
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1053-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS468502OtherCHILDREN'S MERCY/FHP
KS651174OtherBCBS
KSP00624552OtherRR MEDICARE PIN
KS100091010CMedicaid
KS636280OtherFIRST GUARD
KS000975OtherPREFERRED HEALTH SYSTEMS
KS100091010AMedicaid
KS651174OtherBCBS
KST43747Medicare UPIN
KS468502OtherCHILDREN'S MERCY/FHP
KS100091010CMedicaid
KS100091010AMedicaid