Provider Demographics
NPI:1902970213
Name:TOOMBS, WADE BRIAN (OD)
Entity Type:Individual
Prefix:MR
First Name:WADE
Middle Name:BRIAN
Last Name:TOOMBS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 W WALKER ST
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:76424-3230
Mailing Address - Country:US
Mailing Address - Phone:254-559-5431
Mailing Address - Fax:254-559-9828
Practice Address - Street 1:1510 W WALKER ST
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:TX
Practice Address - Zip Code:76424-3230
Practice Address - Country:US
Practice Address - Phone:254-559-5431
Practice Address - Fax:254-559-9828
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5459TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E98VOtherBCBS
TX125621100OtherFIRST CARE
TX1186410001OtherDMERC REGION C - CEDI
TX019593501Medicaid
TX00E98VMedicare PIN
TX1186410001OtherDMERC REGION C - CEDI
TX1902970213Medicare NSC