Ronald T. Wagner, O. D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

K808DT Issued in KY

Practice address

115 Columbia Ave
Glasgow, KY 42141-2903

Phone

(270) 651-8323

Fax

(270) 651-8324

NPI assigned

Jan 5, 2007

Last updated

Mar 29, 2013By 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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in KY

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 of Houston - College of Optometry, 1974

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Edmonton Family Vision Center PSCGroup PAC ID 0042285108, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: direct@wagnereyecarecenterglasgowky.compulinkdirect.com

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.

• Edmonton Family Vision Center PSC

  • Optometrist
  • Edmonton, KY
  • NPI 1275712416
  Medicare reassignment Care Compare group NPD
• Wagner & Wagner PSC

  dba Wagner Eye Care Center

  • Optometrist
  • Glasgow, KY
  • NPI 1124180351
  Authorized official Same address or phone
• John Kenyon American Eye Institute LLC

  dba Eye Surgery Center of Elizabethtown

  • Ambulatory Surgical Clinic/Center
  • Elizabethtown, KY
  • NPI 1013513308
  NPD (past)

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364515200000",
    "number": "1700933298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 638",
            "city": "GLASGOW",
            "state": "KY",
            "postal_code": "421420638",
            "telephone_number": "270-651-8323",
            "fax_number": "270-651-8324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 COLUMBIA AVE",
            "city": "GLASGOW",
            "state": "KY",
            "postal_code": "421412903",
            "telephone_number": "270-651-8323",
            "fax_number": "270-651-8324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "RONALD",
        "middle_name": "T.",
        "credential": "O. D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-05",
        "last_updated": "2013-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "K808DT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000047717",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRI CARE",
            "identifier": "611009062",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77008084",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jose Orlando Vazquez-Vicente, D.O.
• Eric Todd Vessels, M.D.
• Michele Grace Vincent, APRN
• W. Craig Tyree, MD, PLC
• Wagner & Wagner PSC (Wagner Eye Care Center)
• Derrick Wagoner, LPCC
• Irfan Waheed, M.D.
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0711)
• Wal-Mart Stores East, LP (Vision Center 30-0711)
• Amanda Moore Walden, PHARM.D.

• Optometrist in Glasgow, KY
• Providers in Glasgow, KY by specialty
• Optometrist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 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.