Larry L Waggoner, DOCTOR OF OPTOMETRY

Primary specialty

OptometristTaxonomy code 152W00000X

License

6133T Issued in CA

Practice address

12134 Mt Mesa Rd
Lake Isabella, CA 93240

Phone

(760) 379-3602

Fax

(760) 379-2232

NPI assigned

Nov 1, 2006

Sex

Male

Sole proprietor

No

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

Enrolled in CA

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

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.

• Golden State Eye Medical Group Inc

  • Ophthalmology Physician
  • Bakersfield, CA
  • NPI 1205847746

  Optometrist

  Medicare reassignment NPD
• Scripps Health

  • General Acute Care Hospital
  • La Jolla, CA
  • NPI 1841277704
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282521600000",
    "number": "1710065727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12134 MT MESA RD",
            "city": "LAKE ISABELLA",
            "state": "CA",
            "postal_code": "93240",
            "telephone_number": "760-379-3602",
            "fax_number": "760-379-2232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12134 MT MESA RD",
            "city": "LAKE ISABELLA",
            "state": "CA",
            "postal_code": "93240",
            "telephone_number": "760-379-3602",
            "fax_number": "760-379-2232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "LARRY",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "DOCTOR OF OPTOMETRY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2010-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "6133T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Geraldine Ann Unmack
• Walter Edward Urfer, CASE MANAGER
• Aja Diane Vanderlinden
• Vanessa Bernadine-Marie Vasquez
• Chelsea Rose Vega
• JT Walker
• Jackylin Jill Wallace
• Robert Roseburry Weigel Jr.
• Jett Williams
• Wesley Allen Williams, D.C.

• Optometrist in Lake Isabella, CA
• Providers in Lake Isabella, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2010; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.