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Organization
WAGNER OPTICAL INC
Active
Organization
WAGNER OPTICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD JAMES WITT OPTICIAN (PRESIDENT)
(716) 845-6080
Entity
Organization
Contact information
Practice address
945 BROADWAY, BUFFALO, NY 14212-1218
(716) 845-6080
(716) 845-0167
Mailing address
945 BROADWAY, BUFFALO, NY 14212-1218
(716) 845-6080
(716) 845-0167
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
156FX1800X
Optician
—
—
332H00000X
Eyewear Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00011397201
UNIVERA
—
01
—
000390029003
COMMUNITY BLUE
—
05
—
01677123
—
NY
01
—
17227
SPECTERA
—
01
—
49762
FIDELIS
—
01
—
7309888
INDEPENDENT HEALTH
—
01
—
NY3364
EYEMED
—
Enumeration date
01/04/2007
Last updated
10/09/2007
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