Bruce B Wadley, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

5503TG Issued in TX

Practice address

1101 Waters Edge Dr
Suite 104
Granbury, TX 76048-1474

Phone

(817) 579-7933

Fax

(817) 579-8656

NPI assigned

Oct 17, 2005

Last updated

Feb 26, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

University of Houston - College of Optometry, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Granbury Eye Care PCGroup PAC ID 5092809350, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Granbury Eye Care PC

  • Optometrist
  • Granbury, TX
  • NPI 1700071883
  Medicare reassignment Care Compare group NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1267142400000",
    "number": "1184613739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 WATERS EDGE DR",
            "address_2": "SUITE 104",
            "city": "GRANBURY",
            "state": "TX",
            "postal_code": "760481474",
            "telephone_number": "817-579-7933",
            "fax_number": "817-579-8656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 WATERS EDGE DR",
            "address_2": "SUITE 104",
            "city": "GRANBURY",
            "state": "TX",
            "postal_code": "760481474",
            "telephone_number": "817-579-7933",
            "fax_number": "817-579-8656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADLEY",
        "first_name": "BRUCE",
        "middle_name": "B",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-17",
        "last_updated": "2010-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "5503TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0190761",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Vassar
• Sany Prasad Vattakunnel, PHARM D
• James Vaughan
• VT Medical Group, LLC
• Kevin Hieu Vu, D.D.S., M.S., C.D.T
• Nancy Helene Wagner, AGPCNP-BC, A-GNP-C
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-0371)
• Wal-Mart Stores Texas, LP (Vision Center 30-0371)
• Walgreen Co (Walgreens #05921)
• Walgreen Co (Walgreens #21519)

• Optometrist in Granbury, TX
• Providers in Granbury, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.