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General NPI Number Information
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NPI Number | 1952589046
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Entity Type | Organization
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Legal Business Name | DENNIS M. WAGNER OD
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Dates
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Enumeration Date | 01/31/2008
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 2901 CURRY FORD RD SUITE 214
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City | ORLANDO
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State | FL
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Zip | 32806-3300
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Country | US
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Telephone | 407-894-9998
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Fax | 407-894-5512
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Provider Business Mailing Address
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Address Line | 2901 CURRY FORD RD SUITE 214
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City | ORLANDO
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State | FL
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Zip | 32806-3300
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Country | US
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Telephone | 407-894-9998
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Fax | 407-894-5512
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DENNIS MERLE WAGNER
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Credential |
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Telephone | 407-894-9998
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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 | OPC001701
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License Number State | FL
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