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General NPI Number Information
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NPI Number | 1477753838
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Entity Type | Organization
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Legal Business Name | LAUGHLIN AND WADE, OPTOMETRISTS
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 405 LOCUST AVE
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City | FAIRMONT
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State | WV
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Zip | 26554-4717
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Country | US
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Telephone | 304-366-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 405 LOCUST AVE
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City | FAIRMONT
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State | WV
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Zip | 26554-4717
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Country | US
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Telephone | 304-366-2020
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. J KEITH WADE
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Credential | OD
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Telephone | 304-366-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 729OD
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 646OD
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License Number State | WV
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