Provider Demographics
NPI:1386636843
Name:WISE, RONALD E (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:E
Last Name:WISE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:303-493-7000
Mailing Address - Fax:
Practice Address - Street 1:1435 WAZEE ST
Practice Address - Street 2:# 101
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1491
Practice Address - Country:US
Practice Address - Phone:303-299-9473
Practice Address - Fax:303-299-9472
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34013208600000X, 207WX0120X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1841407392OtherKS NPI
CO41535OtherAVESIS
CO0815699OtherAETNA
CO841353910OtherTAX ID#
COWI12401OtherCO BLUE SHIELD
CO18827OtherSPECTERA
COCO4013OtherEYEMED
CO919991020591OtherEYE SPECIALISTS
CO180025514OtherRAILROAD MEDICARE
KS200539900AMedicaid
KS106500OtherKS BLUE SHIELD
CO1340132Medicaid
1467405928OtherGROUP NPI
CO34013OtherVISION BENEFITS OF AMER
KS200539900AMedicaid
180025514Medicare PIN
CO41535OtherAVESIS
CO0815699OtherAETNA
1841407392OtherKS NPI