Individual provider Active NPI

Mecallen Wade Garneau, OD

  • Optometrist
  • Fort Collins, CO
National Provider Identifier
1790601342
Registry record updated Jul 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
0004222 Issued in CO
Practice address
1820 S College Ave # B
Fort Collins, CO 80525-1423
Phone
(307) 763-1779
NPI assigned
Jun 27, 2026
Last updated
Jul 3, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 0004222 CO Primary

Addresses

Primary practice location

1820 S College Ave # B
Fort Collins, CO 80525-1423

Mailing address

1820 S College Ave # B
Fort Collins, CO 80525-1423
Phone (307) 763-1779

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1782518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783036800000",
    "number": "1790601342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 S COLLEGE AVE # B",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805251423",
            "telephone_number": "307-763-1779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1820 S COLLEGE AVE # B",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805251423",
            "telephone_number": "307-763-1779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARNEAU",
        "first_name": "MECALLEN",
        "middle_name": "WADE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-06-27",
        "last_updated": "2026-07-03",
        "certification_date": "2026-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "0004222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2026; 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.