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General NPI Number Information
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NPI Number | 1235608357
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Entity Type | Organization
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Legal Business Name | BIERNACKI WAGNER EYE ASSOCIATES PC
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Dates
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Enumeration Date | 11/19/2018
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Last Update Date | 12/28/2018
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Provider Practice Location Address
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Address Line | 82 S WASHINGTON ST
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City | WILKES BARRE
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State | PA
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Zip | 18701-3029
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Country | US
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Telephone | 570-823-0290
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Fax |
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Provider Business Mailing Address
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Address Line | 82 S WASHINGTON ST
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City | WILKES BARRE
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State | PA
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Zip | 18701-3029
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Country | US
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Telephone | 570-823-0290
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH WAGNER
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Credential | OD
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Telephone | 724-816-4763
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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 |
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License Number State |
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