Provider Demographics
NPI:1154669968
Name:WEGENER, ALAN GORDON (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:GORDON
Last Name:WEGENER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6622 RALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-5359
Mailing Address - Country:US
Mailing Address - Phone:816-896-0225
Mailing Address - Fax:
Practice Address - Street 1:2401 KENTUCKY AVE STE A
Practice Address - Street 2:
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079
Practice Address - Country:US
Practice Address - Phone:816-431-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012027842152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist