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Organization

BARRY A WAGNER OD A PROFESSIONAL CORPORATION

Active
Other names
Optometry Eye Care Centet Dr. B Wagner OD
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BARRY ALAN WAGNER OD (OPTOMETRIST)
(818) 985-2321
Entity
Organization

Contact information

Practice address
12000 VICTORY BLVD, NORTH HOLLYWWOD, CA 91606
(818) 985-2321
(818) 985-6873
Mailing address
12000 VICTORY BLVD, NORTH HOLLYWWOD, CA 91606
(818) 985-2321
(818) 985-6873

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
GSD005410
CA
05
SD0051040
CA
Enumeration date
05/01/2007
Last updated
10/03/2007
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