Wade Allen Konvalin, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4286TG Issued in TX

Practice address

221 N Preston Rd
Ste B
Prosper, TX 75078-8792

Phone

(972) 347-2020

Fax

(972) 347-2072

NPI assigned

Jul 11, 2005

Last updated

Mar 7, 2023By 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 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TX

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

University of Houston - College of Optometry, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Med Southwest PLLCGroup PAC ID 4082952874, 234 clinicians

Practice addresses (Care Compare)

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.

• Med Southwest, PLLC

  dba MyEyeDr.

  • Optometrist
  • Houston, TX
  • NPI 1609348739
  Medicare reassignment Care Compare group NPD
• Prosper Eye Care PA

  dba 1st EyeCare

  • Optometrist
  • Prosper, TX
  • NPI 1588776066
  Authorized official Same address or phone
• Med Southwest, PLLC

  dba MyEyeDr.

  • Optometrist
  • Texarkana, TX
  • NPI 1871059170
  NPD
• Med Southwest, PLLC

  • Optometrist
  • Oklahoma City, OK
  • NPI 1679440762
  NPD
• Longview Eye Associates. PA

  • Optometrist
  • Longview, TX
  • NPI 1790799773
  NPD (past)
• Ward Eye Associates PC

  • Optometrist
  • Marshall, TX
  • NPI 1184208134
  NPD (past)

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

{
    "created_epoch": "1121040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1386642635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 N PRESTON RD",
            "address_2": "STE B",
            "city": "PROSPER",
            "state": "TX",
            "postal_code": "750788792",
            "telephone_number": "972-347-2020",
            "fax_number": "972-347-2072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 N PRESTON RD",
            "address_2": "STE B",
            "city": "PROSPER",
            "state": "TX",
            "postal_code": "750788792",
            "telephone_number": "972-347-2020",
            "fax_number": "972-347-2072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONVALIN",
        "first_name": "WADE",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-11",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "4286TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "81503Q",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTOMETRY LICENSE",
            "identifier": "4286TG",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD PTAN",
            "identifier": "DQ7835",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kiom, LLC
• Chenetta Kirksey, MA, LPC
• Alyssa Knowles, BCBA
• Caroline Ko
• Kimberly Kois, LMT
• Kroger Texas LP (Kroger Pharmacy #573)
• Kroger Texas LP (Kroger Pharmacy #589)
• Tabitha Krop
• Grace Krueger, LPC
• Kofoworola Mariam Kuboye, M.D

• Optometrist in Prosper, TX
• Providers in Prosper, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.