Provider Demographics
NPI:1356425615
Name:WAGNER, TROY LAMAR (OD)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:LAMAR
Last Name:WAGNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:6700 WOODLANDS PKWY
Mailing Address - Street 2:STE 150
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2745
Mailing Address - Country:US
Mailing Address - Phone:281-363-4362
Mailing Address - Fax:281-363-4208
Practice Address - Street 1:6700 WOODLANDS PKWY
Practice Address - Street 2:STE 150
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2745
Practice Address - Country:US
Practice Address - Phone:281-363-4362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6114TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0046FAOtherBCBS
TXU86161Medicare UPIN
TX0046FAOtherBCBS