Provider Demographics
NPI:1295851889
Name:WAGLER, TONY SHAUN (O,D)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:SHAUN
Last Name:WAGLER
Suffix:
Gender:M
Credentials:O,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12609 VALHALLA LN
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7543
Mailing Address - Country:US
Mailing Address - Phone:812-295-7124
Mailing Address - Fax:
Practice Address - Street 1:1537 S SCATTERFIELD RD
Practice Address - Street 2:SUITE #2
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-5766
Practice Address - Country:US
Practice Address - Phone:765-649-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003430A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist