IndividualActive
Irven Wagner, O.D.
NPI 1376687814 · Vision Therapy Optometrist · Santa Rosa, CA
Provider details
- NPI number
- 1376687814
- Entity type
- Individual
- Primary specialty
- Vision Therapy OptometristEye and Vision Services Providers
- Credential
- O.D.
- Sex
- Male
- Sole proprietor
- Yes
- License
- 8372TPA (CA)
Specialties & taxonomies
Eye and Vision Services Providers
Practice location
800 Coddingtown Ctr
Santa Rosa, CA 95401-3511
Phone: (707) 526-1881
Fax: (707) 542-2014
Approximate (ZIP-level) locationGet directions
Mailing address
1945 Piner Rd Spc 118
Santa Rosa, CA 95403-6911
Registry dates
- Enumerated
- 2007-02-17
- Last updated
- 2009-04-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.