| NPI | 1366586505 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY SCOTT WADE President,O.D. 574-273-9233 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18002947B) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2009-05-07 |