Provider Demographics
NPI:1427040633
Name:WIRES, DUANE L (OD)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:L
Last Name:WIRES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OH
Mailing Address - Zip Code:45810-1240
Mailing Address - Country:US
Mailing Address - Phone:419-634-2921
Mailing Address - Fax:419-634-9858
Practice Address - Street 1:107 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OH
Practice Address - Zip Code:45810-1240
Practice Address - Country:US
Practice Address - Phone:419-634-2921
Practice Address - Fax:419-634-9858
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3756152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH055775Medicaid
OHY48178Medicare UPIN