Provider Demographics
NPI:1992716286
Name:WILSON, CADE MALONE (OD)
Entity type:Individual
Prefix:DR
First Name:CADE
Middle Name:MALONE
Last Name:WILSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 E HIGHLAND DR STE 100
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5383
Mailing Address - Country:US
Mailing Address - Phone:870-972-6040
Mailing Address - Fax:870-972-5337
Practice Address - Street 1:2100 E HIGHLAND DR STE 100
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5383
Practice Address - Country:US
Practice Address - Phone:870-972-6040
Practice Address - Fax:870-972-5337
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2540152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152190722Medicaid
ARU97225Medicare UPIN
AR49864Medicare PIN