Provider Demographics
NPI:1720249162
Name:WENDY A. WAGUESPACK, O.D., INC.
Entity Type:Organization
Organization Name:WENDY A. WAGUESPACK, O.D., INC.
Other - Org Name:WENDY A. WAGUESPACK, O.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WAGUESPACK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:225-767-8495
Mailing Address - Street 1:7932 PICARDY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3741
Mailing Address - Country:US
Mailing Address - Phone:225-767-8435
Mailing Address - Fax:225-767-9493
Practice Address - Street 1:7932 PICARDY AVE STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3741
Practice Address - Country:US
Practice Address - Phone:225-767-8435
Practice Address - Fax:225-767-9493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA874-019T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1331139Medicaid
LA5777141OtherAETNA
LA2468BOtherBLUE CROSS
LAT19416Medicare UPIN
LA5777141OtherAETNA