Provider Demographics
NPI:1588755680
Name:WADE, GEORGEANN STEVERMER (OD)
Entity type:Individual
Prefix:DR
First Name:GEORGEANN
Middle Name:STEVERMER
Last Name:WADE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2044 15TH AVE.
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:WI
Mailing Address - Zip Code:54822-4400
Mailing Address - Country:US
Mailing Address - Phone:715-458-3937
Mailing Address - Fax:
Practice Address - Street 1:2044 15TH AVE.
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:WI
Practice Address - Zip Code:54822-4400
Practice Address - Country:US
Practice Address - Phone:715-458-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2643152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38646500Medicaid
WIU65496Medicare UPIN
WI38646500Medicaid