Wayne Halstrom Optometry, Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

5864TPA Issued in CA

Legal business name

WAYNE HALSTROM OPTOMETRY, INC.

Practice address

1123 Newpark Mall
Newark, CA 94560-5246

Phone

(510) 791-2020

NPI assigned

Sep 12, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Wayne Halstrom, OD

Title

President

Phone

(510) 791-2020

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1378944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378944000000",
    "number": "1881029577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1123 NEWPARK MALL",
            "city": "NEWARK",
            "state": "CA",
            "postal_code": "945605246",
            "telephone_number": "510-791-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1123 NEWPARK MALL",
            "city": "NEWARK",
            "state": "CA",
            "postal_code": "945605246",
            "telephone_number": "510-791-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE HALSTROM OPTOMETRY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-12",
        "last_updated": "2013-09-12",
        "status": "A",
        "authorized_official_last_name": "HALSTROM",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-791-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "5864TPA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Newark, CA
• Providers in Newark, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.