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Individual
DR. WADE ALLEN KONVALIN
Active
Individual
DR. WADE ALLEN KONVALIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4286TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4286TG
OPTOMETRY LICENSE
TX
01
—
81503Q
BLUE CROSS BLUE SHIELD
—
01
—
DQ7835
RAILROAD PTAN
TX
Enumeration date
07/11/2005
Last updated
03/07/2023
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