Individual
DR. ELLEN ROGERS WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
806 RIVERSIDE AVE, SUITE 100, JACKSONVILLE, FL 32204-3337
(904) 356-7101
(904) 356-7947
Mailing address
806 RIVERSIDE AVE, SUITE 100, JACKSONVILLE, FL 32204-3337
(904) 356-7101
(904) 356-7947
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2306
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20361
BCBS
FL
01
—
20361A
BCBS
—
Enumeration date
06/07/2006
Last updated
01/05/2018
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