Wade Demordaunt, O.D

NPI 1275591711 · on the registry since 2006

Practice

Address: 1450 N 2nd E
Rexburg, ID 83440
Phone: (208) 497-6406
Fax: (208) 359-3007
Organisation at this address: Walmart Inc.
Diamond Peak Idaho
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 3

Registry record

Primary taxonomy: 152WC0802X
152WC0802X
Also registered as: 152WC0802X
152WC0802X
152W00000X
Licence states on file: ID, UT, AZ, CA
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2016-02-01

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Idaho