Beaudoin & Wade

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

Organization subpart

No

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.

Title

Managing Member

Phone

(920) 735-9580

Specialties & licenses 2

Addresses

Locations

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": []
}

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• All providers in Appleton, WI
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• 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.