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General NPI Number Information
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NPI Number | 1649902008
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Entity Type | Individual
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Provider Name | WADE EDWARD LIGON LICENSED OPTICIAN
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Gender | Male
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Dates
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Enumeration Date | 06/25/2022
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Last Update Date | 06/25/2022
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Provider Practice Location Address
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Address Line | 7520 GARNERS FERRY RD
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City | COLUMBIA
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State | SC
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Zip | 29209-2628
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Country | US
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Telephone | 803-783-8348
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Fax | 803-783-0715
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Provider Business Mailing Address
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Address Line | 3253 BAGNAL DR
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City | COLUMBIA
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State | SC
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Zip | 29204-3425
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Country | US
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Telephone | 803-665-8341
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Fax | 803-783-0715
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 217
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License Number State | SC
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