NPIMap

Organization Active NPI

Beaudoin & Wade

  • Optometrist
  • Appleton, WI
National Provider Identifier
1346498409
Registry record updated Sep 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2210 Issued in WI
Legal business name
BEAUDOIN & WADE
Practice address
2600 W College Ave
Suite #1
Appleton, WI 54914-4200
Phone
(920) 735-9580
Fax
(920) 735-9886
NPI assigned
Sep 3, 2008
Last updated
Sep 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2022

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

Authorized official

Name
Dr. Mark Crawford Wade, O.D.NPI 1104814631
Title
Managing Member
Phone
(920) 735-9580

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 2210 WI Primary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 2226 WI

Addresses

Primary practice location

2600 W College Ave
Suite #1
Appleton, WI 54914-4200

Mailing address

2600 W College Ave
Suite #1
Appleton, WI 54914-4200
Phone (920) 735-9580

National Provider Directory

National Provider Directory

Locations

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663804800000",
    "number": "1346498409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 W COLLEGE AVE",
            "address_2": "SUITE #1",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549144200",
            "telephone_number": "920-735-9580",
            "fax_number": "920-735-9886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 W COLLEGE AVE",
            "address_2": "SUITE #1",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549144200",
            "telephone_number": "920-735-9580",
            "fax_number": "920-735-9886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAUDOIN & WADE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-03",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A",
        "authorized_official_last_name": "WADE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "CRAWFORD",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "920-735-9580",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2210",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2226",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.