Individual
DR. GARY LEE WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
306 SE 4TH ST, MOORE, OK 73160-6707
(405) 794-2020
(405) 794-3768
Mailing address
306 SE 4TH ST, MOORE, OK 73160-6707
(405) 794-2020
(405) 794-3768
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
939
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100766050A
—
OK
Enumeration date
12/09/2005
Last updated
08/30/2012
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