Organization
DR WAGNER SOUTHRIDGE OPTICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOAN E SERRANO (MANAGER)
(414) 855-0469
Entity
Organization
Contact information
Practice address
5300 S 76TH ST, STE 690, GREENDALE, WI 53129-1102
(414) 855-0469
(414) 855-0492
Mailing address
5300 S 76TH ST, STE 690, GREENDALE, WI 53129-1102
(414) 855-0469
(414) 855-0492
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
06/12/2008
Last updated
08/17/2009
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