Wade Ellisor, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

8715-T Issued in TX

Practice address

1714 Kingwood Dr
Kingwood, TX 77339-3046

Phone

(281) 359-2020

Fax

(281) 359-7019

NPI assigned

Jul 7, 2015

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

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, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vision Source - Kingwood, PAGroup PAC ID 9638152267, 6 clinicians

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 and National Provider Directory roles.

• Vision Source - Kingwood, PA

  • Optometrist
  • Kingwood, TX
  • NPI 1265564769
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1436227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436227200000",
    "number": "1497138572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1714 KINGWOOD DR",
            "city": "KINGWOOD",
            "state": "TX",
            "postal_code": "773393046",
            "telephone_number": "281-359-2020",
            "fax_number": "281-359-7019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1714 KINGWOOD DR",
            "city": "KINGWOOD",
            "state": "TX",
            "postal_code": "773393046",
            "telephone_number": "281-359-2020",
            "fax_number": "281-359-7019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISOR",
        "first_name": "WADE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-07",
        "last_updated": "2015-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "8715-T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kim Elliott, MD
• Wanda Elliott, LSA
• Danya Ellis, M.D.
• Erin C Ellisor, OD
• Glenn D Ellisor, O.D.
• Jaleesa Elwin
• Ojomah Angela Emono, M.D.
• Empathetic Insights Counseling and Supervision, PLLC
• Empowered Psychological Services, PLLC
• Rebecca Lynn Endtricht, M.ED.; LPC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2015; 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.