Barry a Wagner OD a Professional Corporation

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

BARRY A WAGNER OD A PROFESSIONAL CORPORATION

Doing business as

Optometry Eye Care Centet Dr. B Wagner OD

Practice address

12000 Victory Blvd
North Hollywwod, CA 91606

Phone

(818) 985-2321

Fax

(818) 985-6873

NPI assigned

May 1, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Barry Alan Wagner, OD

Title

Optometrist

Phone

(818) 985-2321

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Optometry Eye Care Centet Dr. B Wagner OD Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Barry a. Wagner OD a Professional Corporation

  dba Valley Eye Professioals An Optometric Corporation

  • Optometrist
  • Studio City, CA
  • NPI 1336360288

  O20040323001217

  Same enrollment

Tax ID family

Barry a Wagner OD a Professional Corporation2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Barry a. Wagner OD a Professional Corporation

  dba Valley Eye Professioals An Optometric Corporation

  • Optometrist
  • Studio City, CA
  • NPI 1336360288
  NPD tax ID

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Andrew Babayan, O.D.

  • Optometrist
  • Glendale, CA
  • NPI 1750796215
  NPD
• Anna Lam, O.D.

  • Optometrist
  • North Hollywood, CA
  • NPI 1316353220
  NPD (past)
• Michael Varoujan Terzian, O.D.

  • Optometrist
  • Northridge, CA
  • NPI 1134253693
  NPD (past)

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191369600000",
    "number": "1881815777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12000 VICTORY BLVD",
            "city": "NORTH HOLLYWWOD",
            "state": "CA",
            "postal_code": "91606",
            "telephone_number": "818-985-2321",
            "fax_number": "818-985-6873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12000 VICTORY BLVD",
            "city": "NORTH HOLLYWWOD",
            "state": "CA",
            "postal_code": "91606",
            "telephone_number": "818-985-2321",
            "fax_number": "818-985-6873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BARRY A WAGNER OD A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2007-10-03",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "818-985-2321",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0051040",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GSD005410",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optometry Eye Care Centet Dr. B Wagner OD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.