Organization
WAYNE G. WILDE, O.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WAYNE G. WILDE O.D. (OWNER/PRESIDENT)
(248) 698-2000
Entity
Organization
Contact information
Practice address
7074 HIGHLAND RD STE A, WATERFORD, MI 48327-1500
(248) 698-2000
(248) 698-2655
Mailing address
7074 HIGHLAND RD STE A, WATERFORD, MI 48327-1500
(248) 698-2000
(248) 698-2655
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901002777
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900F367410
BCBSM
MI
Enumeration date
09/11/2007
Last updated
06/21/2018
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