Michael Waggoner, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

AR2411 Issued in AR

Practice address

2630 E Citizens Dr Ste 6
Fayetteville, AR 72703-4797

Phone

(479) 582-1212

NPI assigned

Aug 1, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

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, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Focused Family Eye Care PLLCGroup PAC ID 1658634647, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Focused Family Eye Care, PLLC

  • Clinic/Center
  • Fayetteville, AR
  • NPI 1922515808
  Medicare reassignment Care Compare group
• Johnson Chiropractic Center, LLC

  • Chiropractor
  • Fayetteville, AR
  • NPI 1154811412
  NPD (past)

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380153600000",
    "number": "1639185341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2630 E CITIZENS DR STE 6",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034797",
            "telephone_number": "479-582-1212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2630 E CITIZENS DR STE 6",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034797",
            "telephone_number": "479-582-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2013-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AR",
            "license": "AR2411",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127297722",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• W.a. Lucky LLC.
• Wade Kifer D.D.S., P.a.
• Felecia Wade
• Blair Suzanne Wagemann, P.D.
• Hannah Elizabeth Waggener
• Alicia D Wagner
• Lindsey Lea Wagner, LCSW
• Tommy Wagner III
• Madeline Wagnon, M.S., CFY-SLP
• Rachel Elizabeth Wagoner

• Optometrist in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Optometrist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 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.
• 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.