Barry Alan Wagner, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

5104TLG Issued in CA

Practice address

12229 Ventura Blvd
Studio City, CA 91604-2576

Phone

(818) 880-2020

Fax

(818) 880-1888

NPI assigned

Feb 13, 2006

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 2

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.

• Barry a. Wagner OD a Professional Corporation

  • Optometrist
  • Studio City, CA
  • NPI 1336360288

  CA

  Medicare reassignment Authorized official
• Veyep

  • Clinic/Center
  • Studio City, CA
  • NPI 1720769987
  NPD
• Andrew Babayan, OD, Apc.

  • Optometrist
  • North Hollywood, CA
  • NPI 1588309330
  NPD (past)

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

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671667200000",
    "number": "1922071646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5343 FREMANTLE LN",
            "city": "CALABASAS",
            "state": "CA",
            "postal_code": "913023113",
            "telephone_number": "818-880-2020",
            "fax_number": "818-880-1888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12229 VENTURA BLVD",
            "city": "STUDIO CITY",
            "state": "CA",
            "postal_code": "916042576",
            "telephone_number": "818-880-2020",
            "fax_number": "818-880-1888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "BARRY",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-13",
        "last_updated": "2022-12-22",
        "certification_date": "2022-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "5104TLG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GSD005410",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0051040",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vilona Medical Group, Inc.
• Sharon Vincuilla, MAOT, CPDT-KA
• Cecilia Virgen
• Visiting Angels Home Health Care, Inc.
• Vista View Family Therapy, Inc
• Wake Point Recovery LLC
• Rachel Blair Wakeford, LCSW
• Patricia G Waldo, LMFT
• Walgreen Co
• Warby Parker Inc.

• All providers in Studio City, CA
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2022; 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.