Wade Roger Demordaunt, O.D.

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

ODP-959 Issued in ID

Practice address

1450 N 2ND E
Rexburg, ID 83440-5131

Phone

(208) 497-6406

Fax

(208) 359-3007

NPI assigned

May 3, 2006

Last updated

Feb 1, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

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

Illinois College of Optometry at Chicago, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

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.

• Diamond Peak Idaho

  • Optometrist
  • Rexburg, ID
  • NPI 1588039127
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454284800000",
    "number": "1275591711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 158",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834400158",
            "telephone_number": "208-497-6406",
            "fax_number": "208-359-3007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 N 2ND E",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834405131",
            "telephone_number": "208-497-6406",
            "fax_number": "208-359-3007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMORDAUNT",
        "first_name": "WADE",
        "middle_name": "ROGER",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2016-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "ID",
            "license": "ODP-959",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "UT",
            "license": "351670-9934",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "AZ",
            "license": "1853",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14349",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Daybell
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• Amy Lynne Demordaunt, RN
• Kerry Denney, M.ED.
• Dental Health Center
• Dentistry for Kids P.a.
• Jeffrey Kenneth Despot, MS CF-SLP
• Destin Thayne Bep Inc

• Corneal and Contact Management Optometrist in Rexburg, ID
• Providers in Rexburg, ID by specialty
• Corneal and Contact Management Optometrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2016; 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.