Provider Demographics
NPI:1649902008
Name:LIGON, WADE EDWARD (LICENSED OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:WADE
Middle Name:EDWARD
Last Name:LIGON
Suffix:
Gender:M
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3253 BAGNAL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-3425
Mailing Address - Country:US
Mailing Address - Phone:803-665-8341
Mailing Address - Fax:803-783-0715
Practice Address - Street 1:7520 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-2628
Practice Address - Country:US
Practice Address - Phone:803-783-8348
Practice Address - Fax:803-783-0715
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-25
Last Update Date:2022-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC217156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician