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General NPI Number Information
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NPI Number | 1538396197
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Entity Type | Individual
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Provider Name | JESSICA R WAGERS O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/22/2009
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 51 CHESTNUT ST E STE 3
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City | NASHVILLE
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State | IN
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Zip | 47448-7607
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Country | US
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Telephone | 812-988-6877
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Fax | 812-988-6631
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Provider Business Mailing Address
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Address Line | PO BOX 331
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City | NASHVILLE
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State | IN
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Zip | 47448-0331
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Country | US
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Telephone | 812-988-6877
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Fax | 812-988-6631
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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 | 18003598A
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License Number State | IN
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