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Individual

DR. CRYSTAL WADE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LDO

Contact information

Practice address
1240 HIGHWAY 54 W STE 307, FAYETTEVILLE, GA 30214-4563
(678) 834-7411
(678) 834-7414
Mailing address
7492 PARKLAND BND, FAIRBURN, GA 30213-5422
(678) 777-1824

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT3743
GA
152WC0802X
Corneal and Contact Management Optometrist
OPT3743
GA
156FC0800X
Contact Lens Technician/Technologist
LDO002220
GA
156FC0801X
Contact Lens Fitter
LDO002220
GA
156FX1800X
Optician
LDO002220
GA

Other

Enumeration date
05/02/2013
Last updated
05/31/2026
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