Provider Demographics
NPI:1144375742
Name:WALDMAN, ROBERT (OD)
Entity type:Individual
Prefix:PROF
First Name:ROBERT
Middle Name:
Last Name:WALDMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:A
Other - Last Name:WALDMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:8030 AILEEN DR
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-7304
Mailing Address - Country:US
Mailing Address - Phone:440-255-6039
Mailing Address - Fax:
Practice Address - Street 1:8900 MENTOR AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-7304
Practice Address - Country:US
Practice Address - Phone:440-255-7727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3382T1193152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0056572Medicaid
OH0056572Medicaid