Individual
CHAD MICHAEL WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
891 WESTMINSTER ST, PROVIDENCE, RI 02903-4020
(401) 331-7850
(401) 274-4739
Mailing address
2915 BENJAMIN CT SE, OLYMPIA, WA 98501-4807
(360) 754-2817
(360) 456-3894
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OD00003598
WA
152W00000X
Optometrist
Primary
ODTG00743
RI
Other
Enumeration date
05/17/2006
Last updated
06/27/2023
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