Thomas Jeffrey Wagner, OD MS

Primary specialty

OptometristTaxonomy code 152W00000X

License

002282 Issued in CT

Practice address

12 Roosevelt Ave
Mystic, CT 06355-2809

Phone

(860) 536-1313

Fax

(860) 572-7770

NPI assigned

Feb 24, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pennsylvania College of Optometry, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Master of Science

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12109/brand/1/csg/1/fhir/r4
• FHIR API: https://api.platform.athenahealth.com/22893/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Optimystic LLC

  • Optometrist
  • Mystic, CT
  • NPI 1679107411

  CT, Optometrist

  Medicare reassignment NPD Authorized official
• Wagner Industries, Inc.

  • Optometrist
  • Mystic, CT
  • NPI 1770750010
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585008000000",
    "number": "1114993789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 ROUTE 148",
            "city": "KILLINGWORTH",
            "state": "CT",
            "postal_code": "064191107",
            "telephone_number": "860-405-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 ROOSEVELT AVE",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063552809",
            "telephone_number": "860-536-1313",
            "fax_number": "860-572-7770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "THOMAS",
        "middle_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "OD MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-24",
        "last_updated": "2020-03-24",
        "certification_date": "2020-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CT",
            "license": "002282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenalyn D Vergara, PT
• Visions Sight & Learning Center
• Linda Vogel, PH.D.
• Wade Lindsay Chartier Ma Ladc
• Wagner Industries, Inc.
• Cheryl A Walker, APRN
• Jeremy David Wano, D.M.D
• James Paul Watts, DMD
• Neal Weisbrod
• Jennifer Louise Welch, D.C.

• All providers in Mystic, CT
• Optometrist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.