| D E Wadsworth Jr Od Llc | |
|
1936 N Perkins Rd Stillwater OK 74075-2978 | |
| (405) 543-1846 | |
| Not Available |
| Full Name | D E Wadsworth Jr Od Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1936 N Perkins Rd, Stillwater, Oklahoma |
| Authorized Official Name and Position | Darwin E Wadsworth (OWNER) |
| Authorized Official Contact | 4055431846 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| D E Wadsworth Jr Od Llc 1936 N Perkins Rd Stillwater OK 74075-2978 Ph: (405) 543-1846 | D E Wadsworth Jr Od Llc 1936 N Perkins Rd Stillwater OK 74075-2978 Ph: (405) 543-1846 |
| NPI Number | 1801485578 |
|---|---|
| Provider Enumeration Date | 01/15/2021 |
| Last Update Date | 03/17/2021 |
| Medicare PECOS PAC ID | 8527475409 |
|---|---|
| Medicare Enrollment ID | O20210319000711 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801485578 | NPI | - | NPPES |
| 100765550B | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Darwin E Wadsworth |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1386784130 PECOS PAC ID: 6901183615 Enrollment ID: I20170508000341 |
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