Wade, Mark D.
Wade, Mark D. is an individual health care provider with primary practice located at 12601 Olive Blvd , Saint Louis MO 63141-6313. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Wade, Mark D. can be contacted via phone (314) 336-4690.Contact Information
Primary practice address
12601 Olive Blvd
Saint Louis MO 63141-6313
Phone: (314) 336-4690
Fax: (800) 432-6004
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | T02999 | Missouri |
| Eye and Vision Services Providers / Optometrist | 152W00000X | 046-008455 | Illinois |
Profile Details
| NPI number | 1376512137 |
|---|---|
| LBN Legal business name | Wade, Mark D. |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 15th, 2006 |
| Last updated | Dec 19th, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1376512137 | NPPES |
| Missouri | MEDICAID | 313117905 | |
| Missouri | Other | 4210 | |
| Missouri | Other | 108459 | |
| Missouri | MEDICAID | 313117913 | |
| Missouri | Other | 22-01100 | |
| Missouri | Other | 237550 | |
| Missouri | MEDICAID | 046008455 | |
| Missouri | Other | 222865 | |
| Missouri | Other | 116865 | |
| Missouri | Other | 12139 | |
| Missouri | Other | 410048083 |
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