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General NPI Number Information
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NPI Number | 1336360288
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Entity Type | Organization
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Legal Business Name | BARRY A. WAGNER OD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 10/02/2007
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Provider Practice Location Address
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Address Line | 12229 VENTURA BLVD
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City | STUDIO CITY
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State | CA
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Zip | 91604-2576
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Country | US
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Telephone | 818-623-8900
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Fax | 818-623-0978
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Provider Business Mailing Address
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Address Line | 12229 VENTURA BLVD
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City | STUDIO CITY
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State | CA
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Zip | 91604-2576
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Country | US
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Telephone | 818-623-8900
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Fax | 818-623-0978
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | BARRY ALAN WAGNER
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Credential | OD
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Telephone | 818-985-2321
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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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