Provider Demographics
NPI:1609896521
Name:PERRY M WAGGONER MD LTD
Entity Type:Organization
Organization Name:PERRY M WAGGONER MD LTD
Other - Org Name:NEVADA CENTRE EYE PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:MIMS
Authorized Official - Last Name:WAGGONER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:775-322-3311
Mailing Address - Street 1:650 SIERRA ROSE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2072
Mailing Address - Country:US
Mailing Address - Phone:775-322-3311
Mailing Address - Fax:775-322-8388
Practice Address - Street 1:650 SIERRA ROSE DR
Practice Address - Street 2:SUITE B
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2072
Practice Address - Country:US
Practice Address - Phone:775-322-3311
Practice Address - Fax:775-322-8388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMD7268207W00000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Not Answered208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
34495Medicare ID - Type Unspecified
F58998Medicare UPIN