Healthcare Provider Details

I. General information

NPI: 1598224271
Provider Name (Legal Business Name): WADAS OPTOMETRIC GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 STATE RT 12
BARNEVELD NY
13304-2533
US

IV. Provider business mailing address

8010 STATE RT 12
BARNEVELD NY
13304-2533
US

V. Phone/Fax

Practice location:
  • Phone: 315-896-3900
  • Fax: 315-896-3905
Mailing address:
  • Phone: 315-896-3900
  • Fax: 315-896-3905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA M SCALISE
Title or Position: OWNER
Credential: OD
Phone: 315-723-7898