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General NPI Number Information
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NPI Number | 1457463150
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Entity Type | Individual
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Provider Name | WILLIAM SCOTT WAGNER OD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 635 ANDERSON RD STE 1
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City | DAVIS
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State | CA
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Zip | 95616-3505
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Country | US
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Telephone | 530-756-5040
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Fax | 530-756-9140
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Provider Business Mailing Address
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Address Line | 1700 ALHAMBRA BLVD STE 202
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City | SACRAMENTO
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State | CA
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Zip | 95816-7050
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Country | US
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Telephone | 916-731-8040
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Fax | 916-454-4152
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPT9116
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License Number State | CA
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