Provider Demographics
NPI:1013998558
Name:DULIN, WADE G (OD)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:G
Last Name:DULIN
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 1:2330 AMIDON AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67204-5630
Mailing Address - Country:US
Mailing Address - Phone:316-838-7797
Mailing Address - Fax:316-838-7809
Practice Address - Street 1:2330 AMIDON AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67204-5630
Practice Address - Country:US
Practice Address - Phone:316-838-7797
Practice Address - Fax:316-838-7809
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1067-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS005119OtherBCBS OF KANSAS
KSP00791194OtherRR MEDICARE
KST77467Medicare UPIN