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General NPI Number Information
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NPI Number | 1831369032
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Entity Type | Organization
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Legal Business Name | WADE B TOOMBS
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 1510 W WALKER ST
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City | BRECKENRIDGE
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State | TX
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Zip | 76424-3230
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Country | US
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Telephone | 254-559-5431
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Fax | 254-559-9828
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Provider Business Mailing Address
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Address Line | 1510 W WALKER ST
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City | BRECKENRIDGE
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State | TX
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Zip | 76424-3230
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Country | US
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Telephone | 254-559-5431
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Fax | 254-559-9828
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Authorized Official
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Title or Position | OWNER
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Name | WADE BRIAN TOOMBS
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Credential | O.D.
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Telephone | 254-559-5431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 5459TG
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License Number State | TX
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