Barry a. Wagner OD a Professional Corporation

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

BARRY A. WAGNER OD A PROFESSIONAL CORPORATION

Practice address

12229 Ventura Blvd
Studio City, CA 91604-2576

Phone

(818) 623-8900

Fax

(818) 623-0978

NPI assigned

May 1, 2007

Organization subpart

No

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

Authorized official

Name

Barry Alan Wagner, ODNPI 1922071646

Title

Optometrist

Phone

(818) 985-2321

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Valley Eye Professioals An Optometric Corporation Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Barry a Wagner OD a Professional Corporation

  • Optometrist
  • North Hollywwod, CA
  • NPI 1881815777

  O20040323001217

  Same enrollment

Tax ID family

Barry a Wagner OD a Professional Corporation2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Barry a Wagner OD a Professional Corporation

  • Optometrist
  • North Hollywwod, CA
  • NPI 1881815777
  NPD tax ID

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Barry Alan Wagner, OD

  • Optometrist
  • Studio City, CA
  • NPI 1922071646

  CA

  Medicare reassignment Authorized official
• Andrew Babayan, O.D.

  • Optometrist
  • Glendale, CA
  • NPI 1750796215

  CA, Optometrist

  Medicare reassignment NPD
• Narbae Avedian, O.D.

  • Optometrist
  • Studio City, CA
  • NPI 1992104756
  NPD (past)
• Tyna Pedram, O.D.

  • Optometrist
  • Los Angeles, CA
  • NPI 1578819462
  NPD (past)
• Michael Varoujan Terzian, O.D.

  • Optometrist
  • Northridge, CA
  • NPI 1134253693
  NPD (past)

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191283200000",
    "number": "1336360288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12229 VENTURA BLVD",
            "city": "STUDIO CITY",
            "state": "CA",
            "postal_code": "916042576",
            "telephone_number": "818-623-8900",
            "fax_number": "818-623-0978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12229 VENTURA BLVD",
            "city": "STUDIO CITY",
            "state": "CA",
            "postal_code": "916042576",
            "telephone_number": "818-623-8900",
            "fax_number": "818-623-0978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BARRY A. WAGNER OD A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2007-10-02",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "818-985-2321",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0051040",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GSD005410",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Eye Professioals An Optometric Corporation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jamee P Ball, FNP
• James Hager Bargelt, PH.D.
• Annika Barinholtz, PSY.D.
• Robert A. Barnes, M.D.
• Kennedi Paige Barnett
• Jennifer G Bartolome Optometry Corp, O.D.
• Florentina Custodia Basilio, RPH
• Alexandra Bass
• Bata Group Inc
• Lisa M Bates, PMHNP

• All providers in Studio City, CA
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.