Ellen Rogers Wagner, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2306 Issued in FL

Practice address

806 Riverside Ave
Suite 100
Jacksonville, FL 32204-3337

Phone

(904) 356-7101

Fax

(904) 356-7947

NPI assigned

Jun 7, 2006

Sex

Female

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 2

Medicare fee-for-service enrollment

Enrolled in FL

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

University Alabama Birmingham - School of Optometry, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Karen S Wolf OD and Gil Houston OD PAGroup PAC ID 1254392665, 3 clinicians

Myeyedr Optometry of Florida, LLCGroup PAC ID 0143541037, 141 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Karen S Wolf OD & Gil Houston OD PA

  dba Ponte Vedra Eye Associates

  • Optometrist
  • Ponte Vedra Beach, FL
  • NPI 1598952897
  Medicare reassignment Care Compare group NPD
• Myeyedr Optometry of Florida, LLC

  dba MyEyeDr.

  • Optometrist
  • Tallahassee, FL
  • NPI 1073907028
  Medicare reassignment Care Compare group NPD
• Myeyedr Optometry of Florida, LLC

  dba MyEyeDr.

  • Optometrist
  • Jacksonville, FL
  • NPI 1457712689
  NPD
• Myeyedr Optometry of Florida, LLC

  • Optometrist
  • Clearwater, FL
  • NPI 1730054594
  NPD
• Myeyedr Optometry of Florida, LLC

  dba Myeyedr

  • Optometrist
  • Perry, FL
  • NPI 1437537529
  NPD (past)

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515110400000",
    "number": "1316987753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 RIVERSIDE AVE",
            "address_2": "SUITE 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322043337",
            "telephone_number": "904-356-7101",
            "fax_number": "904-356-7947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 RIVERSIDE AVE",
            "address_2": "SUITE 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322043337",
            "telephone_number": "904-356-7101",
            "fax_number": "904-356-7947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ELLEN",
        "middle_name": "ROGERS",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-07",
        "last_updated": "2018-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "2306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "20361",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "20361A",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexis Wagner, OTR/L
• Bryan J Wagner, OT, ATC, LAT
• Christy Wagner, APRN
• Debra Lynn Wagner, CNM, ARNP
• Elaine C. Wagner, D.D.S.
• Kendra Anne Wagner, LMHC
• Kyle Wagner, DPT
• Laura J Wagner, LCSW
• Marie Pierrette Wagner
• Robert Fredrick Wagner Jr., D.D.S.

• Optometrist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2018; 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.