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Individual

DR. THOMAS JEFFREY WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD MS

Contact information

Practice address
12 ROOSEVELT AVE, MYSTIC, CT 06355-2809
(860) 536-1313
(860) 572-7770
Mailing address
540 ROUTE 148, KILLINGWORTH, CT 06419-1107
(860) 405-5555

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
002282
CT

Other

Enumeration date
02/24/2006
Last updated
03/24/2020
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