Mark D. Wade, O.D.
Individual provider Active NPI Optometrist · Saint Louis, MO
NPI 1376512137 · NPPES record last updated Dec 19, 2012
Key facts
- NPI
- 1376512137
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- T02999 (MO)
- Practice address
- 12601 Olive Blvd
Saint Louis, MO 63141-6313 - Phone
- (314) 336-4690
- Fax
- (800) 432-6004
- NPI assigned
- Mar 15, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Illinois College of Optometry at Chicago, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Nucrown, LLC
Practice addresses (Care Compare)
10465 Saint Charles Rock Rd
Saint Ann, MO 63074-1829
Phone (314) 423-2010
11615 Olive Blvd
Suite B
Creve Coeur, MO 63141-7095
Phone (314) 567-3884
4145 Lindell Blvd
Saint Louis, MO 63108-2913
Phone (314) 533-1898
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL, MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040622000116 | IL | Practitioner - Optometry | 8527043868 | Reassigns benefits to 2 organizations |
| I20101105000548 | MO | Practitioner - Optometry | 8527043868 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046-008455 | IL | MD | Optometrist |
| T02999 | MO | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nu-Crown, LLC | Optometrist | Current |
Accepting new patients |
| Paige Hedgpath Odpc | Optometrist | Current |
Accepting new patients |
| Nucrown,Inc. | Optometrist | Current |
Accepting new patients |
| Christina J. Levi O D P C | Optometrist | Current |
Accepting new patients |
| Paige Hedgpath OD,PC | Optometrist | Current |
Accepting new patients |
| Christina J. Levi O D P C | Optometrist | Past |
Accepting new patients |
Locations
211 E Broadway
Alton, IL 62002
Phone (314) 787-0681
406 E Broadway
Alton, IL 62002
Phone (618) 462-0340
2100 Troy Rd
Edwardsville, IL 62025
Phone (618) 656-8888
1400 Forum Blvd
Columbia, MO 65203
Phone (573) 446-0331
1400 Forum Blvd
Ste 14
Columbia, MO 65203
Phone (573) 446-0331
1709 Missouri Blvd
Ste Ijk
Jefferson City, MO 65109
Phone (573) 635-1313
323 Monroe St
Jefferson Cty, MO 65101
Phone (573) 635-1313
4645 Osage Beach Pkwy
Ste G
Osage Beach, MO 65065
Phone (573) 635-1313
10465 Saint Charles Rock Rd
Saint Ann, MO 63074
Phone (314) 423-2010
4145 Lindell Blvd
Saint Louis, MO 63108
Phone (314) 533-1898
12601 Olive Blvd
Saint Louis, MO 63141
Phone (314) 878-2222
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | T02999 | MO | Yes |
| Optometrist | 152W00000X | 046-008455 | IL |
Addresses
Primary practice location
12601 Olive Blvd
Saint Louis, MO 63141-6313
Mailing address
211 E Broadway
Alton, IL 62002-6220
Phone (314) 336-4690
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 313117905 | Medicaid | MO | |
| 4210 | Other | MO | MISSOURI MEDICAID |
| 108459 | Other | BLUE CROSS BLUE SHIELD MO | |
| 313117913 | Medicaid | MO | |
| 22-01100 | Other | UNITED HEALTHCARE | |
| 237550 | Other | HELATHLINK | |
| 046008455 | Medicaid | IL | |
| 222865 | Other | GROUP HEALTH PLAN | |
| 116865 | Other | EYEMED | |
| 12139 | Other | OPTICARE MEDICARE COMPLET | |
| 410048083 | Other | IL | RR MEDICARE |
Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.