Michael Scott Wagner, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD61308446 Issued in WA

Practice address

16708 Bothell Everett Hwy Ste 103
Mill Creek, WA 98012-6345

Phone

(425) 481-4440

NPI assigned

Jun 3, 2022

Last updated

Jun 3, 2022By the provider in NPPES

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 WA

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

Southern College of Optometry, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Olympia Vision Clinic and Contact Lens Center, PLLCGroup PAC ID 8820080237, 10 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Olympia Vision Clinic and Contact Lens Center, PLLC

  • Optometrist
  • Olympia, WA
  • NPI 1962544692
  Medicare reassignment Care Compare group NPD
• Steven a. Davis. O.D., P.S.

  dba Mill Creek Family Eye Center

  • Optometrist
  • Mill Creek, WA
  • NPI 1427242981
  Medicare reassignment NPD
• Mill Creek Family Eyewear

  • Optometrist
  • Mill Creek, WA
  • NPI 1922633270
  NPD

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

{
    "created_epoch": "1654214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654214400000",
    "number": "1215676572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16708 BOTHELL EVERETT HWY STE 103",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980126345",
            "telephone_number": "425-481-4440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16708 BOTHELL EVERETT HWY STE 103",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980126345",
            "telephone_number": "425-481-4440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MICHAEL",
        "middle_name": "SCOTT",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-03",
        "last_updated": "2022-06-03",
        "certification_date": "2022-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD61308446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vivian Joy Physical Therapy, PLLC
• Ashley Voag
• Tracy Voegeli, OD
• Elenora P Von, MSW, LICSW
• Shobhna Wadhwa, MS
• Matthew Wah, PT
• Dariusz Walczak, MD
• Karen L Wallace, RD, CD
• Nicole Michelle Walsh, LMP
• Kim A Walter, DDS

• Optometrist in Mill Creek, WA
• Providers in Mill Creek, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2022; 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.