Larry E Waggoner O D Prof Corp
NPI #1336449388 in Lake Isabella, California
Provider Information
- NPI Number
- 1336449388
- Entity Type
- Organization
- Organization Name
- Larry E Waggoner O D Prof Corp
- Primary Specialty
- Optometrist
- Enumeration Date
- Oct 25, 2010
- Last Updated
- Nov 22, 2010
Practice Location
- Address
- 12134 MOUNT MESA RD
- City
- Lake Isabella
- State
- California
- ZIP Code
- 93240-9690
- Phone
- (760) 379-3602
Authorized Official
- Name
- DR. LARRY E. WAGGONER, O. D.
- Title
- OWNER/OPTOMETRIST
- Phone
- (760) 379-3602
Specialties & Taxonomy Codes
| Specialty |
|---|
| Optometrist |
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