MEDICARE: RONALD E WISE MD PC

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	152WC0802X	Corneal and Contact Management Optometrist
2	207W00000X	Ophthalmology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DF6087	OTHER	CO	RR MEDICARE GROUP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	020591	OTHER	CO	EYESPECIALISTS LOCATION #
3	110359756	OTHER	CO	DENVER RETAIL SALES LICEN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	RWO12401	OTHER		ANTHEM BS

General Provider Information

NPI Number	:	1467405928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD E WISE MD PC

Provider Business Mailing 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

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	:	OWNER
Name	:	RONALD E WISE
Credential	:	M.D.
Telephone Number	:	303-299-9473

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	09/20/2011

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Directions to “RONALD E WISE MD PC ” Practice Location

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