Provider Demographics
NPI:1407296296
Name:WADE, LINDSAY LORIN (OD)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:LORIN
Last Name:WADE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:LORIN
Other - Last Name:REDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3818 DIEBOLD RANCH RD
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-9671
Mailing Address - Country:US
Mailing Address - Phone:989-295-3222
Mailing Address - Fax:
Practice Address - Street 1:1407 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-6901
Practice Address - Country:US
Practice Address - Phone:989-217-3075
Practice Address - Fax:989-217-3003
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004765152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1407296296Medicaid