Provider Demographics
NPI:1275636508
Name:WAGLER, JAMES WESLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WESLEY
Last Name:WAGLER
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 1:1333 BELLBROOK RD.
Mailing Address - Street 2:
Mailing Address - City:LOOGOOTEE
Mailing Address - State:IN
Mailing Address - Zip Code:47553
Mailing Address - Country:US
Mailing Address - Phone:812-295-5529
Mailing Address - Fax:
Practice Address - Street 1:4040 N NEWTON ST
Practice Address - Street 2:WAL-MART VISION CENTER
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-2575
Practice Address - Country:US
Practice Address - Phone:812-481-2484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003020B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist