MEDICARE: MR. GARY WOLF OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2853	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366447039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY WOLF OD

Provider Business Mailing Address
First Line	:	PO BOX 909
Second Line	:
City	:	PALMER
State	:	MA
Zip	:	01069-0909
Country	:	US
Telephone Number	:	413-283-2946
Fax Number	:	413-283-3631

Provider Business Practice Location Address
First Line	:	1140 THORNDIKE ST
Second Line	:
City	:	PALMER
State	:	MA
Zip	:	01069-1509
Country	:	US
Telephone Number	:	413-283-2946
Fax Number	:	413-283-3631

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	01/29/2008

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Directions to “ MR. GARY WOLF OD” Practice Location

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