Provider Demographics
NPI:1710928239
Name:WAGERS, DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:WAGERS
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 1:890 CENTURY DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4375
Mailing Address - Country:US
Mailing Address - Phone:717-697-1414
Mailing Address - Fax:717-697-4921
Practice Address - Street 1:890 CENTURY DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-4375
Practice Address - Country:US
Practice Address - Phone:717-697-1414
Practice Address - Fax:717-697-4921
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000284152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1793030Medicaid
PA1793030Medicaid
PA034449KHMMedicare ID - Type Unspecified