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General NPI Number Information
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NPI Number | 1639111289
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Entity Type | Organization
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Legal Business Name | WADE E YOUNG MD INC
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 04/28/2022
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Provider Practice Location Address
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Address Line | 60 ASHWOOD DR
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City | TIFFIN
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State | OH
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Zip | 44883-1908
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Country | US
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Telephone | 419-448-8811
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Fax | 419-448-7418
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Provider Business Mailing Address
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Address Line | 60 ASHWOOD DR
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City | TIFFIN
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State | OH
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Zip | 44883-1908
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Country | US
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Telephone | 419-448-8811
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Fax | 419-448-7418
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Authorized Official
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Title or Position | PRESIDENT
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Name | BLAIR YOUNG CLARK
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Credential | DO
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Telephone | 194-488-8811
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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 | 4855T1825
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 35050815
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License Number State | OH
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