Healthcare Provider Details

I. General information

NPI: 1790601342
Provider Name (Legal Business Name): MECALLEN WADE GARNEAU OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 S COLLEGE AVE # B
FORT COLLINS CO
80525-1423
US

IV. Provider business mailing address

1820 S COLLEGE AVE # B
FORT COLLINS CO
80525-1423
US

V. Phone/Fax

Practice location:
  • Phone: 307-763-1779
  • Fax:
Mailing address:
  • Phone: 307-763-1779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0004222
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: