Active NPI
James P Wagner, OD
- Optometrist
- Greendale, WI
National Provider Identifier
1902026206
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2645-035
- Practice address
- 5300 S 76TH St
Ste 690
Greendale, WI 53129-1102 - Phone
- (414) 855-0469
- Fax
- (414) 855-0492
- NPI assigned
- Apr 27, 2007
- Last updated
- Jul 29, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2645-035 | WI | Primary |
Addresses
Primary practice location
5300 S 76TH St
Ste 690
Greendale, WI 53129-1102
Mailing address
5300 S 76TH St
Ste 690
Greendale, WI 53129-1102
Phone (414) 855-0469
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 810571047 | Other | WI | TAX ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2645-035 | WI | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1248825600000",
"number": "1902026206",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5300 S 76TH ST",
"address_2": "STE 690",
"city": "GREENDALE",
"state": "WI",
"postal_code": "531291102",
"telephone_number": "414-855-0469",
"fax_number": "414-855-0492"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5300 S 76TH ST",
"address_2": "STE 690",
"city": "GREENDALE",
"state": "WI",
"postal_code": "531291102",
"telephone_number": "414-855-0469",
"fax_number": "414-855-0492"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "JAMES",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-27",
"last_updated": "2009-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WI",
"license": "2645-035",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "810571047",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greendale, WI
- Nebojsa Vesic, OD
- Village of Greendale (Greendale Fire Department)
- Village of Greendale
- Visionworks, Inc. (Visionworks)
- Visiting Medical Associates
- Wal-Mart Stores East LP (WalMart Pharmacy 10-5668)
- Samantha Jean Walczak, CFY-SLP
- Walgreen Co (Walgreens #04556)
- Mary Louise Wierzbicki, OTR
- Brian J. Wimmer, LCSW
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.