Individual
BRUCE B WADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1101 WATERS EDGE DR, SUITE 104, GRANBURY, TX 76048-1474
(817) 579-7933
(817) 579-8656
Mailing address
1101 WATERS EDGE DR, SUITE 104, GRANBURY, TX 76048-1474
(817) 579-7933
(817) 579-8656
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5503TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0190761
—
TX
Enumeration date
10/17/2005
Last updated
02/26/2010
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