| Doctor Name: | DR. BRET BOUTON WAGENHORST |
| NPI Number: | 1841201134 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 044138 |
| Business Practice Address: | 1803 Old Ocilla Rd Tifton, GA - 317941617 |
| Business Phone Number: | 2293862181 |
| Business Fax Number: | 2293862193 |
| Mailing Address: | 1803 Old Ocilla Rd, TIFTON |
| State: | GA |
| Postal Code: | 317941617 |
| Phone Number: | 2293862181 |
| Fax Number: | 2293862193 |
| NPI Enumeration Date: | 08/11/2006 |
| NPI Last Update Date: | 02/04/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207W00000X |
| License Number: | 044138 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Ophthalmology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |