Individual
ALAN LEWIS WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6160 KEMPSVILLE CIR STE 120B, NORFOLK, VA 23502-3933
(757) 481-4400
(757) 481-1285
Mailing address
6160 KEMPSVILLE CIR STE 250B, NORFOLK, VA 23502-3933
(757) 481-4400
(757) 481-1285
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0101039260
VA
207WX0107X
Retina Specialist (Ophthalmology) Physician
0101039260
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006396097
—
VA
01
—
044061
ANTHEM
VA
01
—
202826
CIGNA
VA
01
—
27210
OPTIMA
VA
Enumeration date
11/30/2005
Last updated
08/13/2019
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