Loren C Wakham, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3433T Issued in TX

Practice address

505 E Mockingbird LN
Victoria, TX 77904-2043

Phone

(361) 578-2904

Fax

(361) 578-7931

NPI assigned

Jan 11, 2007

Last updated

Mar 27, 2013By 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Allison Eye Care, PLLC

  • Optometrist
  • Victoria, TX
  • NPI 1376088088
  Medicare reassignment NPD
• Bates & Harris O D Inc

  dba Texas State Optical of Victoria

  • Optometrist
  • Victoria, TX
  • NPI 1417973280
  Authorized official Same address or phone

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364342400000",
    "number": "1275683104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 E MOCKINGBIRD LN",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779042043",
            "telephone_number": "361-578-2904",
            "fax_number": "361-578-7931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 E MOCKINGBIRD LN",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779042043",
            "telephone_number": "361-578-2904",
            "fax_number": "361-578-7931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAKHAM",
        "first_name": "LOREN",
        "middle_name": "C",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2013-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "3433T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "037012401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Derrick C Wagner, FNP-C
• Donna RM Wagner, M.D.
• Erin Leigh Wagner
• Pamela Coy Wagner, RN, FNP
• William Jordan Wagner Jr., M.D.
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-0330)
• Wal-Mart Stores Texas LLC (WalMart Pharmacy 10-4194)
• Wal-Mart Stores Texas, LLC (Wal-Mart Vision Center 30-4194)
• Wal-Mart Stores Texas, LP (Vision Center 30-0330)
• Brian Robert Walford, CRNA

• Optometrist in Victoria, TX
• Providers in Victoria, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.