Individual
RONALD T. WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O. D.
Contact information
Practice address
115 COLUMBIA AVE, GLASGOW, KY 42141-2903
(270) 651-8323
(270) 651-8324
Mailing address
PO BOX 638, GLASGOW, KY 42142-0638
(270) 651-8323
(270) 651-8324
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
K808DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000047717
BLUE CROSS BLUE SHIELD
KY
01
—
611009062
TRI CARE
KY
05
—
77008084
—
KY
Enumeration date
01/05/2007
Last updated
03/29/2013
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