Provider Demographics
NPI:1962687541
Name:DAL-WAD INC
Entity Type:Organization
Organization Name:DAL-WAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:214-957-3108
Mailing Address - Street 1:10611 GARLAND RD STE 216
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-4800
Mailing Address - Country:US
Mailing Address - Phone:214-321-6753
Mailing Address - Fax:214-320-1015
Practice Address - Street 1:10611 GARLAND RD STE 216
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-4800
Practice Address - Country:US
Practice Address - Phone:214-321-6753
Practice Address - Fax:214-320-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0879880001Medicare NSC