MEDICARE: WADE G DULIN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1067-3	KS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00791194	OTHER	KS	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	005119	OTHER	KS	BCBS OF KANSAS

General Provider Information

NPI Number	:	1013998558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WADE G DULIN OD

Provider Business Mailing Address
First Line	:	2330 AMIDON AVE
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67204-5630
Country	:	US
Telephone Number	:	316-838-7797
Fax Number	:	316-838-7809

Provider Business Practice Location Address
First Line	:	2330 AMIDON AVE
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67204-5630
Country	:	US
Telephone Number	:	316-838-7797
Fax Number	:	316-838-7809

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	04/06/2010

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