William W Wagnon M D P a

NPI #1154687747 in Jasper, Texas

Provider Information

NPI Number: 1154687747
Entity Type: Organization
Organization Name: William W Wagnon M D P a
Primary Specialty: Eyewear Supplier
Enumeration Date: Apr 9, 2012
Last Updated: Jun 22, 2012

Practice Location

Address: 1421 S WHEELER ST
City: Jasper
State: Texas
ZIP Code: 75951-5149
Phone: (936) 632-6111

Authorized Official

Name: WILLIAM WAGNON, MD
Title: OWNER
Phone: (936) 632-6111

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Eyewear Supplier	332H00000X	Primary

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