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Contact Information

IRVEN R WAGNER, OD
800 CODDINGTOWN CTR
SANTA ROSA, CA95401-3511
 Phone: 707-526-1881
 Fax: 707-542-2014
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Vision Therapy

152WV0400X 41 Optometry
Indicates primary specialty

NPI Profile & details for IRVEN R WAGNER · (Male)

NPI Number 1376687814
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 02/17/2007
Last updated 04/22/2009 - About 17 years ago
Sole proprietor 1 Yes
Identifiers
  • CA License # 8372TPA
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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