Provider Demographics
NPI:1588714877
Name:JOHN R WADE, OD, INC.
Entity type:Organization
Organization Name:JOHN R WADE, OD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-934-2117
Mailing Address - Street 1:1049 STATE ROAD 229
Mailing Address - Street 2:PO BOX 149
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-6808
Mailing Address - Country:US
Mailing Address - Phone:812-934-2117
Mailing Address - Fax:812-933-0913
Practice Address - Street 1:1049 STATE ROAD 229
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-6808
Practice Address - Country:US
Practice Address - Phone:812-934-2117
Practice Address - Fax:812-933-0913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001811B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0328580001Medicare NSC