Provider Demographics
NPI:1275783318
Name:WADE FAMILY EYE CARE, SC
Entity Type:Organization
Organization Name:WADE FAMILY EYE CARE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGEANN
Authorized Official - Middle Name:STEVERMER
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-458-3937
Mailing Address - Street 1:2044 15TH AVE.
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:WI
Mailing Address - Zip Code:54822-4400
Mailing Address - Country:US
Mailing Address - Phone:715-458-3937
Mailing Address - Fax:715-458-3938
Practice Address - Street 1:2044 15TH AVE.
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:WI
Practice Address - Zip Code:54822-4400
Practice Address - Country:US
Practice Address - Phone:715-458-3937
Practice Address - Fax:715-458-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2643152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38646500Medicaid
U65496Medicare UPIN
WIWI1040Medicare PIN
WI38646500Medicaid