Provider Demographics
NPI:1821448358
Name:WADAS, MATTHEW J (OD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:WADAS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:38 ROOSEVELT DR
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492-1550
Mailing Address - Country:US
Mailing Address - Phone:315-736-3217
Mailing Address - Fax:315-736-6979
Practice Address - Street 1:38 ROOSEVELT DR
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:NY
Practice Address - Zip Code:13492-1550
Practice Address - Country:US
Practice Address - Phone:315-736-3217
Practice Address - Fax:315-736-6979
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008427152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist