MEDICARE: RONALD E WISE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	34013	CO
2	207WX0120X	Cornea and External Diseases Specialist Physician	34013	CO
3	207W00000X	Ophthalmology Physician	34013	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	180025514	OTHER	CO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1841407392	OTHER		KS NPI
2	41535	OTHER	CO	AVESIS
3	0815699	OTHER	CO	AETNA
4	841353910	OTHER	CO	TAX ID#
5	WI12401	OTHER	CO	CO BLUE SHIELD
6	18827	OTHER	CO	SPECTERA
7	CO4013	OTHER	CO	EYEMED
8	919991020591	OTHER	CO	EYE SPECIALISTS
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	106500	OTHER	KS	KS BLUE SHIELD
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	1467405928	OTHER		GROUP NPI
14	34013	OTHER	CO	VISION BENEFITS OF AMER

General Provider Information

NPI Number	:	1386636843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD E WISE MD

Provider Business Mailing Address
First Line	:	PO BOX 110429
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80042-0429
Country	:	US
Telephone Number	:	303-493-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1435 WAZEE ST
Second Line	:	# 101
City	:	DENVER
State	:	CO
Zip	:	80202-1491
Country	:	US
Telephone Number	:	303-299-9473
Fax Number	:	303-299-9472

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	03/28/2018

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1467405928 — RONALD E WISE MD PC
Practice Location Address:

1435 WAZEE ST , #101
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80202-1491

Practice Phone: 303-299-9473
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1255543393 — LODO DENTAL PC
Practice Location Address:

1435 WAZEE ST STE 102
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1154980118 — UNIVERSITY OF COLORADO HOSPITAL AUTHORITY
Practice Location Address:

1435 WAZEE ST STE 101
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Practice Phone: 970-329-9754
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1770641698 — DR. TRENTON SCOTT D.C.
Practice Location Address:

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Directions to “ RONALD E WISE MD” Practice Location

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