Provider Demographics
NPI:1730536178
Name:WALDROP, MARIE TEKLA ELEANOR (OD)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:TEKLA ELEANOR
Last Name:WALDROP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MARIE
Other - Middle Name:TEKLA ELEANOR
Other - Last Name:BOLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:411 TULIP WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-6200
Mailing Address - Country:US
Mailing Address - Phone:402-416-4061
Mailing Address - Fax:
Practice Address - Street 1:3610 W NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-7702
Practice Address - Country:US
Practice Address - Phone:402-415-4061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1464152W00000X
TX9053T152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Yes152W00000XEye and Vision Services ProvidersOptometrist