Individual
MR. FREDERICK JOSEPH WAGNER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
101 KIMBALL RD, CARLISLE, MA 01741
(978) 371-2337
(978) 371-2297
Mailing address
101 KIMBALL RD, CARLISLE, MA 01741
(978) 371-2337
(978) 371-2297
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2408
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0320668
—
MA
Enumeration date
02/21/2007
Last updated
07/08/2007
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