Provider Demographics
NPI:1861568644
Name:WAYNE, ROBERT PIERCE JR (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PIERCE
Last Name:WAYNE
Suffix:JR
Gender:M
Credentials:OD
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Mailing Address - Street 1:1250 SE BISHOP BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5449
Mailing Address - Country:US
Mailing Address - Phone:509-332-7424
Mailing Address - Fax:509-332-7364
Practice Address - Street 1:1250 SE BISHOP BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5449
Practice Address - Country:US
Practice Address - Phone:509-332-7424
Practice Address - Fax:509-332-7364
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-25
Last Update Date:2008-05-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA0001623TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000301978Medicare ID - Type Unspecified
0347410001Medicare NSC
T02448Medicare UPIN