Provider Demographics
NPI:1457393688
Name:MALTZ, WAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:
Last Name:MALTZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:WAYNE
Other - Middle Name:
Other - Last Name:MALTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:5774 FM 1960 RD W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-4204
Mailing Address - Country:US
Mailing Address - Phone:281-440-5887
Mailing Address - Fax:281-440-0368
Practice Address - Street 1:5774 FM 1960 RD W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4204
Practice Address - Country:US
Practice Address - Phone:281-440-5887
Practice Address - Fax:281-440-0368
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2671T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2671TOtherOPTOMETRY LICENSE
TX2671TOtherOPTOMETRY LICENSE
TXT14572Medicare UPIN
TX8B6414Medicare PIN