Provider Demographics
NPI:1720566300
Name:WAGNER, CASSANDRA ALISON (OD)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:ALISON
Last Name:WAGNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 PRESTON RD STE 1126
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-9472
Mailing Address - Country:US
Mailing Address - Phone:972-731-9859
Mailing Address - Fax:
Practice Address - Street 1:2601 PRESTON RD STE 1126
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:972-731-9859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-05
Last Update Date:2018-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9570152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9570OtherTEXAS OD LICENSE NUMBER