Healthcare Provider Details

I. General information

NPI: 1841390937
Provider Name (Legal Business Name): BRIAN WINFIELD WADMAN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 01/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 BERNARDSTON RD SUITE 101
GREENFIELD MA
01301-1238
US

IV. Provider business mailing address

489 BERNARDSTON RD SUITE 101
GREENFIELD MA
01301-1238
US

V. Phone/Fax

Practice location:
  • Phone: 413-772-2571
  • Fax: 413-772-2266
Mailing address:
  • Phone: 413-772-2571
  • Fax: 413-772-2266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3259
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: