Individual
DR. JAMES P WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
5300 S 76TH ST, STE 690, GREENDALE, WI 53129-1102
(414) 855-0469
(414) 855-0492
Mailing address
5300 S 76TH ST, STE 690, GREENDALE, WI 53129-1102
(414) 855-0469
(414) 855-0492
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2645-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
810571047
TAX ID
WI
Enumeration date
04/27/2007
Last updated
07/29/2009
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