Bruce Wagner OD

NPI 1053434035 - Optometrist - 152W00000X

NPI Details
NPI 1053434035
Gender Female
Enumeration Date 04/06/2007
Last Updated 07/08/2007
Entity Type Individual
Active Over 9 years ago
Practice Location
24040 CAMINO DEL AVION STE E
MONARCH BEACH CA, 92629-4005, US
Phone (949) 443-9110
Fax
Business Location
24040 CAMINO DEL AVION STE E
MONARCH BEACH CA, 92629-4005, US
Phone (949) 443-9110
Fax
Toxanomy
Taxonomy Code 152W00000X
License State California
License Number 6376
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According to our database, Bruce Wagner OD NPI is 1053434035, taxonomy code is 152W00000X and license number is 6376, license state is located at California. Bruce Wagner OD physically located at 24040 Camino Del Avion Ste E, Monarch Beach CA, 92629-4005. NPI Number Bruce Wagner OD has the Individual type.

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1053434035 NPI number is provided on an as is basis without warranty of any kind. 1053434035 is maintained by the National Plan & Provider Enumeration System. The contents of Bruce Wagner OD are for informational purposes only.