MEDICARE: DR. ALAN GORDON WEGENER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2012027842	MO

General Provider Information

NPI Number	:	1154669968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN GORDON WEGENER O.D.

Provider Business Mailing Address
First Line	:	42 WESTWOODS DR
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64068-3519
Country	:	US
Telephone Number	:	816-781-0500
Fax Number	:	816-336-6966

Provider Business Practice Location Address
First Line	:	42 WESTWOODS DR
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64068-3519
Country	:	US
Telephone Number	:	816-781-0500
Fax Number	:	816-336-6966

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2013
Last Update Date	:	01/06/2026

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