Individual
CRYSTAL WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LDO
Contact information
Practice address
1240 HIGHWAY 54 W, 306, FAYETTEVILLE, GA 30214-4557
(678) 304-7129
(877) 543-7919
Mailing address
7492 PARKLAND BND, FAIRBURN, GA 30213-5422
(678) 777-1824
Taxonomy
Speciality
Code
Description
License number
State
156FC0800X
Contact Lens Technician/Technologist
LDO002220
GA
156FC0801X
Contact Lens Fitter
LDO002220
GA
156FX1800X
Optician
Primary
LDO002220
GA
Other
Enumeration date
05/02/2013
Last updated
05/02/2014
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