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Individual
DR. RICK WAYNE IDETA
Active
Individual
DR. RICK WAYNE IDETA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT8503TPA
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
191148
SAFEGUARD INS
CA
01
—
3636
MEDICAL EYE SERVICES INS
CA
05
—
SD0085030
—
CA
Enumeration date
05/17/2006
Last updated
03/03/2010
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