Organization
OPTIMYSTIC LLC
Active
Other names
OptiMystic Eye Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS JEFFREY WAGNER OD (MEMBER)
(860) 536-1313
Entity
Organization
Contact information
Practice address
12 ROOSEVELT AVE, MYSTIC, CT 06355-2809
(860) 536-1313
(860) 572-7770
Mailing address
12 ROOSEVELT AVE, MYSTIC, CT 06355-2809
(860) 536-1313
(860) 572-7770
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
03/02/2020
Last updated
03/24/2020
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