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DR. WADE ROGER DEMORDAUNT O.D. NPI 1275591711


NPI Information

NPI: 1275591711
Provider Name: DR. WADE ROGER DEMORDAUNT, O.D.
Classification: Optometrist - 152WC0802X
Entity Type: Individual

Specialization: Corneal and Contact Management

PECOS Registration: Yes

Address:
1450 N 2ND E
REXBURG, ID
ZIP 83440
Phone: (208) 497-6406
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DR. Wade Roger Demordaunt, O.D. is a corneal and contact management optometrist in Rexburg, ID with 28 years of experience. The provider is the professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea's ability to sustain successful contact lens wear, and treatment of any external eye or corneal condition which can affect contact lens wear. DR. Wade Roger Demordaunt, O.D. NPI is 1275591711. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: ILLINOIS COLLEGE OF OPTOMETRY AT CHICAGO
Graduation Year:1996

The provider's business location address is:

1450 N 2ND E
REXBURG, ID
ZIP 83440-131
Phone: (208) 497-6406
Fax: (208) 359-3007

The NPI 1275591711 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 5/3/2006 and was last updated on 2/1/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1152WC0802XOptometristCorneal and Contact Management351670-9934UTAHNo
2152WC0802XOptometristCorneal and Contact Management1853ARIZONANo
3152W00000XOptometrist14349CALIFORNIANo
4152WC0802XOptometristCorneal and Contact ManagementODP-959IDAHOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1U65669MEDICARE UPINUTAH

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.