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General NPI Number Information
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NPI Number | 1063561587
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Entity Type | Organization
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Legal Business Name | WAGNER OPTOMETRY PC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 12/02/2009
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Provider Practice Location Address
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Address Line | 10071 WADSWORTH PKWY STE. 200
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City | WESTMINSTER
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State | CO
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Zip | 80021-3804
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Country | US
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Telephone | 303-427-2020
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Fax | 303-427-6197
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Provider Business Mailing Address
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Address Line | 10071 WADSWORTH PKWY STE. 200
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City | WESTMINSTER
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State | CO
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Zip | 80021-3804
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Country | US
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Telephone | 303-427-2020
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Fax | 303-427-6197
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT H. WAGNER
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Credential | O.D.
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Telephone | 303-427-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18-11667-0000
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License Number State | CO
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