Individual
DR. JEFFREY SCOTT WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
155 E UNIVERSITY DR, GRANGER, IN 46530-4474
(574) 243-7732
Mailing address
50571 PRESTONWOOD CT, GRANGER, IN 46530-4963
(574) 274-0117
(574) 875-5171
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002947B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200204300A
—
IN
01
—
35-2132356
TAX ID#
IN
Enumeration date
10/15/2006
Last updated
04/02/2025
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