Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT5223TLG | CA |
NPI | 1013072396 |
---|---|
Provider Name | Dr. David Tadao Wakabayashi |
First Address | Irvine, CA 92604-0323 |
Second Address | Irvine, CA 92604-0323 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 08/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20949 | (02) |