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General NPI Number Information
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NPI Number | 1932629052
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Entity Type | Organization
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Legal Business Name | ROBERT A WADE OD PC
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Dates
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Enumeration Date | 06/20/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4001 COLLEGE AVE
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City | BLUEFIELD
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State | VA
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Zip | 24605-2043
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Country | US
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Telephone | 276-322-2347
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Fax | 276-322-4812
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Provider Business Mailing Address
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Address Line | 4001 COLLEGE AVE
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City | BLUEFIELD
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State | VA
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Zip | 24605-2043
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Country | US
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Telephone | 276-322-2347
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Fax | 276-322-4812
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT A WADE
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Credential | OD
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Telephone | 276-322-2347
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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 | 0618001786
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License Number State | VA
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