Provider Demographics
NPI:1538396197
Name:WAGERS, JESSICA R (OD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:WAGERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 331
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47448-0331
Mailing Address - Country:US
Mailing Address - Phone:812-988-6877
Mailing Address - Fax:812-988-6631
Practice Address - Street 1:51 CHESTNUT ST E
Practice Address - Street 2:STE 3
Practice Address - City:NASHVILLE
Practice Address - State:IN
Practice Address - Zip Code:47448-7607
Practice Address - Country:US
Practice Address - Phone:812-988-6877
Practice Address - Fax:812-988-6631
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003598A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist