Healthcare Provider Details

I. General information

NPI: 1841407392
Provider Name (Legal Business Name): RONALD E WISE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W 2ND ST
GOODLAND KS
67735-1602
US

IV. Provider business mailing address

1435 WAZEE ST # 101
DENVER CO
80202-1491
US

V. Phone/Fax

Practice location:
  • Phone: 785-890-3625
  • Fax: 785-890-6373
Mailing address:
  • Phone: 303-299-9473
  • Fax: 303-299-9472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number04-32515
License Number StateKS

VIII. Authorized Official

Name: DR. RONALD E WISE
Title or Position: OWNER
Credential: M.D.
Phone: 303-299-9473