Wagner Industries, Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

002282 Issued in CT

Legal business name

WAGNER INDUSTRIES, INC.

Practice address

5 Water St
C/O Optimystic
Mystic, CT 06355-2507

Phone

(860) 536-1313

NPI assigned

May 15, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Thomas Jeffrey Wagner, O.D., M.S.NPI 1114993789

Title

Owner/Optometrist

Phone

(860) 405-5555

Specialties & licenses 1

Addresses

Other names 1

• OptiMystic Doing business as

Locations

Practitioners 1

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

• Thomas Jeffrey Wagner, OD MS

  • Optometrist
  • Mystic, CT
  • NPI 1114993789
  NPD (past) Authorized official

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

{
    "created_epoch": "1210809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210809600000",
    "number": "1770750010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 ROUTE 148",
            "city": "KILLINGWORTH",
            "state": "CT",
            "postal_code": "064191107",
            "telephone_number": "860-405-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 WATER ST",
            "address_2": "C/O OPTIMYSTIC",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063552507",
            "telephone_number": "860-536-1313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGNER INDUSTRIES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-15",
        "last_updated": "2008-05-15",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "860-405-5555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D., M.S."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CT",
            "license": "002282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OptiMystic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lisa Venditto, MA
• Jenalyn D Vergara, PT
• Visions Sight & Learning Center
• Linda Vogel, PH.D.
• Wade Lindsay Chartier Ma Ladc
• Thomas Jeffrey Wagner, OD MS
• Cheryl A Walker, APRN
• Jeremy David Wano, D.M.D
• James Paul Watts, DMD
• Neal Weisbrod

• All providers in Mystic, CT
• Optometrist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2008; 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.