Individual provider Active NPI

Mark Wade, OD

  • Optometrist
  • Appleton, WI
National Provider Identifier
1104814631
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2210 Issued in WI
Practice address
2700 W College Ave
Appleton, WI 54914-2918
Phone
(920) 735-9580
NPI assigned
Oct 10, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2210 WI Primary

Addresses

Primary practice location

2700 W College Ave
Appleton, WI 54914-2918

Mailing address

2700 W College Ave
Appleton, WI 54914-2918
Phone (920) 735-9580

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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

Enrollment IDStateProvider typePAC IDDetails
I20081126000438 WI Practitioner - Optometry 5890855415 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Stellar Eye Care SCGroup PAC ID 6608124508, 3 clinicians

Practice addresses (Care Compare)

2600 W College Ave
Suite 1
Appleton, WI 54914-4200
Phone (920) 735-9914

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2210WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Stellar Eye Care SC Optometrist CurrentSince Jan 1, 2024 Accepting new patients
Eyemart Express LTD Past Accepting new patients

Locations

2600 W College Ave
Ste 1
Appleton, WI 54914
Phone (920) 735-9580

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1104814631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 W COLLEGE AVE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549142918",
            "telephone_number": "920-735-9580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 W COLLEGE AVE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549142918",
            "telephone_number": "920-735-9580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADE",
        "first_name": "MARK",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-10",
        "last_updated": "2026-07-13",
        "certification_date": "2023-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.