Irven Robert Wagner, O.D.

Primary specialty

Vision Therapy OptometristTaxonomy code 152WV0400X

License

8372TPA Issued in CA

Practice address

800 Coddingtown Ctr
Santa Rosa, CA 95401-3511

Phone

(707) 526-1881

Fax

(707) 542-2014

NPI assigned

Feb 17, 2007

Last updated

Apr 22, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1171670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240358400000",
    "number": "1376687814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1945 PINER RD SPC 118",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954036911",
            "telephone_number": "707-526-1881",
            "fax_number": "707-542-2014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 CODDINGTOWN CTR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954013511",
            "telephone_number": "707-526-1881",
            "fax_number": "707-542-2014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "IRVEN",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-17",
        "last_updated": "2009-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "CA",
            "license": "8372TPA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Wagener, PSY.D.
• Kelly Johanna Waggener, D.M.D
• Alix Vitacco Wagner, PPSC
• Andrew Stephen Wagner, MD
• Eric Wagner
• Jennifer Wagner
• Richard C Wagner
• Susan D. Wagner, MFT
• Madeleine Waldmann, MFT
• Walgreen Co (Walgreens #03297)

• Vision Therapy Optometrist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Vision Therapy Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.