Organization
WAGNER INDUSTRIES, INC.
Active
Other names
OptiMystic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS JEFFREY WAGNER O.D., M.S. (OWNER/OPTOMETRIST)
(860) 405-5555
Entity
Organization
Contact information
Practice address
5 WATER ST, C/O OPTIMYSTIC, MYSTIC, CT 06355-2507
(860) 536-1313
Mailing address
540 ROUTE 148, KILLINGWORTH, CT 06419-1107
(860) 405-5555
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
002282
CT
Other
Enumeration date
05/15/2008
Last updated
05/15/2008
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