MEDICARE: WADE E YOUNG MD INC

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	4855T1825	OH
2	207W00000X	Ophthalmology Physician	35050815	OH

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639111289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WADE E YOUNG MD INC

Provider Business Mailing Address
First Line	:	60 ASHWOOD DR
Second Line	:
City	:	TIFFIN
State	:	OH
Zip	:	44883-1908
Country	:	US
Telephone Number	:	419-448-8811
Fax Number	:	419-448-7418

Provider Business Practice Location Address
First Line	:	60 ASHWOOD DR
Second Line	:
City	:	TIFFIN
State	:	OH
Zip	:	44883-1908
Country	:	US
Telephone Number	:	419-448-8811
Fax Number	:	419-448-7418

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BLAIR YOUNG CLARK
Credential	:	DO
Telephone Number	:	194-488-8811

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	04/28/2022

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Directions to “WADE E YOUNG MD INC ” Practice Location

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