Provider Demographics
NPI:1467405928
Name:RONALD E WISE MD PC
Entity Type:Organization
Organization Name:RONALD E WISE MD PC
Other - Org Name:THE WISE VISION GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-299-9473
Mailing Address - Street 1:1435 WAZEE ST
Mailing Address - Street 2:# 101
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1491
Mailing Address - Country:US
Mailing Address - Phone:303-299-9473
Mailing Address - Fax:303-299-9472
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODF6087OtherRR MEDICARE GROUP #
CO020591OtherEYESPECIALISTS LOCATION #
CO110359756OtherDENVER RETAIL SALES LICEN
CO90074084Medicaid
RWO12401OtherANTHEM BS
CO110359756OtherDENVER RETAIL SALES LICEN
CO110359756OtherDENVER RETAIL SALES LICEN
DF6087Medicare PIN
KS111339Medicare PIN