Provider Demographics
NPI:1023761103
Name:GRUPE, BLADE ARON (OD)
Entity type:Individual
Prefix:DR
First Name:BLADE
Middle Name:ARON
Last Name:GRUPE
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 1:118 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ALMA CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:54611-7711
Mailing Address - Country:US
Mailing Address - Phone:715-896-5626
Mailing Address - Fax:
Practice Address - Street 1:1626 TUTTLE ST STE 1
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1501
Practice Address - Country:US
Practice Address - Phone:608-356-2020
Practice Address - Fax:608-355-7055
Is Sole Proprietor?:No
Enumeration Date:2022-01-30
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003891152W00000X
390200000X
WI3984152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1023761103Medicaid