Individual
DR. BARRY ALAN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
12229 VENTURA BLVD, STUDIO CITY, CA 91604-2576
(818) 880-2020
(818) 880-1888
Mailing address
5343 FREMANTLE LN, CALABASAS, CA 91302-3113
(818) 880-2020
(818) 880-1888
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5104TLG
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GSD005410
—
CA
05
—
SD0051040
—
CA
Enumeration date
02/13/2006
Last updated
12/22/2022
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