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Organization
LARRY E WAGGONER O D PROF CORP
Active
Organization
LARRY E WAGGONER O D PROF CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY E. WAGGONER O. D. (OWNER/OPTOMETRIST)
(760) 379-3602
Entity
Organization
Contact information
Practice address
12134 MOUNT MESA RD, LAKE ISABELLA, CA 93240-9690
(760) 379-3602
(760) 379-2232
Mailing address
12134 MOUNT MESA RD, LAKE ISABELLA, CA 93240-9690
(760) 379-3602
(760) 379-2232
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
6133
CA
Other
Enumeration date
10/25/2010
Last updated
11/22/2010
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