Provider Demographics
NPI:1427088178
Name:WADLEY, CASWELL HUGHES (O D)
Entity type:Individual
Prefix:DR
First Name:CASWELL
Middle Name:HUGHES
Last Name:WADLEY
Suffix:
Gender:M
Credentials:O D
Other - Prefix:DR
Other - First Name:C.
Other - Middle Name:HUGHES
Other - Last Name:WADLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:O D
Mailing Address - Street 1:PO BOX 1129
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-1129
Mailing Address - Country:US
Mailing Address - Phone:931-363-4557
Mailing Address - Fax:931-424-0778
Practice Address - Street 1:118 N 3RD ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-3200
Practice Address - Country:US
Practice Address - Phone:931-363-4557
Practice Address - Fax:931-424-0778
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1309152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3597789Medicaid
TN0253650001Medicare NSC
TNU28542Medicare UPIN
TN3597789Medicare PIN