Organization
WAGNER FAMILY EYECARE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID A WAGNER OD (OWNER/OPTOMETRIST)
(814) 677-6636
Entity
Organization
Contact information
Practice address
3285 STATE ROUTE 257, SENECA, PA 16346-2529
(814) 677-6636
(814) 677-9562
Mailing address
PO BOX 307, SENECA, PA 16346-0307
(814) 677-6636
(814) 677-9562
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0EG000125
PA
152W00000X
Optometrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014195820006
—
PA
Enumeration date
02/11/2008
Last updated
11/14/2017
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