| Doctor Name: | RICHARD W. WAGNER |
| NPI Number: | 1689626582 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | OD |
| License Number: | 2419 |
| Business Practice Address: | 218 N Main St (us 19) Chiefland, FL - 32626 |
| Business Phone Number: | 3524934448 |
| Business Fax Number: | 3524908100 |
| Mailing Address: | P.o. Box 2622, CHIEFLAND |
| State: | FL |
| Postal Code: | 32644 |
| Phone Number: | 1352493444 |
| Fax Number: | 1352490810 |
| NPI Enumeration Date: | 05/17/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 152WC0802X |
| License Number: | 2419 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Optometrist |
| Taxonomy Specialization: | Corneal and Contact Management |
| Taxonomy Definition: | The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea |