Provider Demographics
NPI:1508987074
Name:BAGGETT, WENDY D (LDO)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:D
Last Name:BAGGETT
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 LATESHA TER
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-9388
Mailing Address - Country:US
Mailing Address - Phone:386-325-0209
Mailing Address - Fax:
Practice Address - Street 1:514 S PALM AVE
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-4148
Practice Address - Country:US
Practice Address - Phone:386-328-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO4734156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician