Provider Demographics
NPI:1922160423
Name:WADLEY, JAMES WESLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WESLEY
Last Name:WADLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:JIMMY
Other - Middle Name:
Other - Last Name:WADLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:262 S LEGGETT DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-1628
Mailing Address - Country:US
Mailing Address - Phone:325-676-2125
Mailing Address - Fax:325-673-8160
Practice Address - Street 1:262 S LEGGETT DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-1628
Practice Address - Country:US
Practice Address - Phone:325-676-2125
Practice Address - Fax:325-673-8160
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2767T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E61TMedicare UPIN