MR. WADE THOMAS DURHAM (NPI# 1972695104) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972695104 |
| Entity Type | Individual |
| Full Name | MR. WADE THOMAS DURHAM |
| Credential | OPTICIAN |
| Practice Address |
940 N Main St Bushnell FL 33513-5008 |
| Mailing Address |
807 Crestview Cir N Wildwood FL 34785-3535 |
| Practice Telephone | 3525680442 |
| Practice Fax Number | 3525682902 |
| Mailing Telephone | 3523300226 |
| Mailing Fax Number | 3525682902 |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 156FX1800X |
Technician/Technologist Specialization: Optician |
DO 1085 | FL | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | EYEMED VISION CARE | 111217 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700809936 | Wade Durham | Social Worker | 725 N 12th Ave, Arcadia, FL 34266-8752 | 2006-07-26 |
| Street Address |
940 N MAIN ST |
| City | BUSHNELL |
| State | FL |
| Zip Code | 33513-5008 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770742777 | Durham Optical, Inc | Technician/Technologist | 940 N Main St, Bushnell, FL 33513-5008 | 2008-06-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619465481 | Crystal Wallace Goddin | Physical Therapy Assistant | 1104 N Main St, Bushnell, Fl, Bushnell, FL 33513 | 2018-04-27 |
| 1255836920 | Anton Dawson | Behavior Technician | 2310 Cr 615, Bushnell, FL 33513 | 2018-03-26 |
| 1942728431 | Carolyn Sue Guarino | Licensed Practical Nurse | 10306 S.w. 53rd Terr., Bushnell, FL 33513 | 2017-09-05 |
| 1326321258 | Edith Marie Evans | Case Manager/Care Coordinator | 2891 C.r. 615b, Bushnell, FL 33513 | 2011-09-27 |
| 1144478439 | Emma J Ridley | Pharmacist | Sumter Oaks Park, 4602 Couny Rd. 673, #14107, Bushnell, FL 33513 | 2008-08-29 |
| 1205083268 | Diana K Mullin | Day Training, Developmentally Disabled Services | 9325 Cr 622 G, Bushnell, FL 33513 | 2008-08-21 |
| 1467625202 | Amy's Caring Hands | Day Training, Developmentally Disabled Services | 1612 W County Road 476, Bushnell, FL 33513 | 2008-04-11 |
| 1821212952 | Stuart J Kaufman Md & Assoc Pa | Ophthalmology | 1814 West Cr 48, Bushnell, FL 33513 | 2007-04-12 |
| 1740201128 | Winn Dixie Stores Inc | Durable Medical Equipment & Medical Supplies | 1122 N Main St, Bushnell, FL 33513 | 2006-07-21 |
| 1184688947 | Florida Department of Health | Public Health or Welfare | 415 E Noble Ave, Bushnell, FL 33513 | 2006-04-17 |
| Find all providers in zip 33513 | ||||
| Taxonomy Code | 156FX1800X |
| Grouping | Eye and Vision Services Providers |
| Classification | Technician/Technologist |
| Specialization | Optician |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770742777 | Durham Optical, Inc | Technician/Technologist | 940 N Main St, Bushnell, FL 33513-5008 | 2008-06-04 |
| 1154412591 | Wal-mart Stores East, Lp | Technician/Technologist | 2163 W C 48, Bushnell, FL 33513-8999 | 2006-09-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538767405 | Michelle Mattera Starkey | Technician/Technologist | 1633 Taylor Rd # 104, Port Orange, FL 32128-6754 | 2020-10-13 |
| 1346848249 | Elizabeth Mary Howard | Technician/Technologist | 1633 Taylor Rd Unit 104, Port Orange, FL 32128-6754 | 2020-10-13 |
| 1992311492 | Conway Optical Company | Technician/Technologist | 3834 Curry Ford Rd, Orlando, FL 32806-2708 | 2020-09-20 |
| 1689283160 | Magnum Bien Aime | Technician/Technologist | 1860 N Pine Island Rd Ste 105, Plantation, FL 33322-5234 | 2020-07-30 |
| 1073121430 | Elvira R Diez | Technician/Technologist | 950 Bluewood Ter, Weston, FL 33327-2049 | 2020-07-21 |
| 1598373219 | Jocelyn Dorfils | Technician/Technologist | 4135 Dr Martin Luther King Blvd, Fort Myers, FL 33916-4809 | 2020-07-20 |
| 1376161000 | Carla Stocker | Technician/Technologist | 7410 Daetwyler Dr, Orlando, FL 32812-3726 | 2020-07-09 |
| 1306464292 | Christian Gonzalez | Technician/Technologist | 4135 Dr Martin Luther King Blvd # G16, Fort Myers, FL 33916-4809 | 2020-07-08 |
| 1245867902 | Cindy Perry Toepfer | Technician/Technologist | 264 Tamiami Trl S, Venice, FL 34285-2419 | 2020-03-24 |
| 1518593367 | Sand Vision LLC | Technician/Technologist | 706 Sw Pine Island Rd # 102, Cape Coral, FL 33991 | 2020-03-12 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.