Individual
DR. MARK D. WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
12601 OLIVE BLVD, SAINT LOUIS, MO 63141-6313
(314) 336-4690
(800) 432-6004
Mailing address
211 E BROADWAY, ALTON, IL 62002-6220
(314) 336-4690
(800) 432-6004
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
046-008455
IL
152W00000X
Optometrist
Primary
T02999
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046008455
—
IL
01
—
108459
BLUE CROSS BLUE SHIELD MO
—
01
—
116865
EYEMED
—
01
—
12139
OPTICARE MEDICARE COMPLET
—
01
—
22-01100
UNITED HEALTHCARE
—
01
—
222865
GROUP HEALTH PLAN
—
01
—
237550
HELATHLINK
—
05
—
313117905
—
MO
05
—
313117913
—
MO
01
—
410048083
RR MEDICARE
IL
01
—
4210
MISSOURI MEDICAID
MO
Enumeration date
03/15/2006
Last updated
12/19/2012
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