Provider Demographics
NPI:1366586505
Name:WADE EYE ASSOCIATES, INC.
Entity type:Organization
Organization Name:WADE EYE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT,O.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:574-273-9233
Mailing Address - Street 1:50600 WOODBURY WAY
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-6902
Mailing Address - Country:US
Mailing Address - Phone:574-273-9233
Mailing Address - Fax:574-287-9999
Practice Address - Street 1:50600 WOODBURY WAY
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-6902
Practice Address - Country:US
Practice Address - Phone:574-273-9233
Practice Address - Fax:574-287-9999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002947B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1134219447OtherNIP# JEFF WADE, O.D.
IN1174622856OtherNPI# JENNIFER WADE, O.D