Provider Demographics
NPI:1376530709
Name:CULBERTSON, WAYNE EDWARD (OD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:EDWARD
Last Name:CULBERTSON
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 1:10740 N CENTRAL EXPY STE 250
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2142
Mailing Address - Country:US
Mailing Address - Phone:214-253-0202
Mailing Address - Fax:214-253-0203
Practice Address - Street 1:10740 N CENTRAL EXPY STE 250
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2161
Practice Address - Country:US
Practice Address - Phone:214-253-0202
Practice Address - Fax:214-253-0203
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6009TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00212PMedicare ID - Type UnspecifiedMEDICARE NUMBER
TXT65084Medicare UPIN