Wade, Gary Lee
Wade, Gary Lee is an sole proprietor health care provider with primary practice located at 306 Se 4Th St , Moore OK 73160-6707. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Wade, Gary Lee can be contacted via phone (405) 794-2020.Contact Information
Primary practice address
306 Se 4Th St
Moore OK 73160-6707
Phone: (405) 794-2020
Fax: (405) 794-3768
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 939 | Oklahoma |
Profile Details
| NPI number | 1245215524 |
|---|---|
| LBN Legal business name | Wade, Gary Lee |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 9th, 2005 |
| Last updated | Aug 30th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1245215524 | NPPES |
| Oklahoma | MEDICAID | 100766050A |
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