Basic Information
| Provider Information | |||||||||
| NPI: | 1386784130 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WADSWORTH | ||||||||
| FirstName: | DARWIN | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1555 PALM BEACH LAKES BLVD | ||||||||
| Address2: | STE 600 | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334012333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619659110 | ||||||||
| FaxNumber: | 5616847754 | ||||||||
| Practice Location | |||||||||
| Address1: | 9436 E 51ST ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741459033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186223926 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 04/18/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1096 | OK | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.