Individual
DR. IRVEN ROBERT WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
800 CODDINGTOWN CTR, SANTA ROSA, CA 95401-3511
(707) 526-1881
(707) 542-2014
Mailing address
1945 PINER RD SPC 118, SANTA ROSA, CA 95403-6911
(707) 526-1881
(707) 542-2014
Taxonomy
Speciality
Code
Description
License number
State
152WV0400X
Vision Therapy Optometrist
Primary
8372TPA
CA
Other
Enumeration date
02/17/2007
Last updated
04/22/2009
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