Organization
BARRY A. WAGNER OD A PROFESSIONAL CORPORATION
Active
Other names
Valley Eye Professioals An Optometric Corporation
Organization subpart
No
Provider details
NPI number
Authorized official
BARRY ALAN WAGNER OD (OPTOMETRIST)
(818) 985-2321
Entity
Organization
Contact information
Practice address
12229 VENTURA BLVD, STUDIO CITY, CA 91604-2576
(818) 623-8900
(818) 623-0978
Mailing address
12229 VENTURA BLVD, STUDIO CITY, CA 91604-2576
(818) 623-8900
(818) 623-0978
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GSD005410
—
CA
05
—
SD0051040
—
CA
Enumeration date
05/01/2007
Last updated
10/02/2007
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