Demordaunt, Wade Roger

Demordaunt, Wade Roger is an individual health care provider with primary practice located at 1450 N 2Nd E , Rexburg ID 83440-5131. He recently has 2 registered licenses in different health care specialties including Eye and Vision Services Providers / Corneal and Contact Management, Eye and Vision Services Providers / Optometrist. Eye and Vision Services Providers / Corneal and Contact Management is his primary health care specialty. Demordaunt, Wade Roger can be contacted via phone (208) 497-6406.

Contact Information

Primary practice address
1450 N 2Nd E Rexburg ID 83440-5131
Phone: (208) 497-6406
Fax: (208) 359-3007
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Corneal and Contact Management 152WC0802X ODP-959 Idaho
Eye and Vision Services Providers / Corneal and Contact Management 152WC0802X 351670-9934 Utah
Eye and Vision Services Providers / Corneal and Contact Management 152WC0802X 1853 Arizona
Eye and Vision Services Providers / Optometrist 152W00000X 14349 California

Profile Details

NPI number 1275591711
LBN Legal business name Demordaunt, Wade Roger
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 3rd, 2006
Last updated Feb 1st, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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