Provider Demographics
NPI:1447260245
Name:MCGONIGAL, WENDY M (OD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:M
Last Name:MCGONIGAL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 S MARION AVE
Mailing Address - Street 2:NORTH FLORIDA/SOUTH GEORGIA VETERANS HEALTH SYSTEM
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-5808
Mailing Address - Country:US
Mailing Address - Phone:386-755-3016
Mailing Address - Fax:386-754-6423
Practice Address - Street 1:619 S MARION AVE
Practice Address - Street 2:NORTH FLORIDA/SOUTH GEORGIA VETERANS HEALTH SYSTEM
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-5808
Practice Address - Country:US
Practice Address - Phone:386-755-3016
Practice Address - Fax:386-754-6423
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4861/T1726152W00000X
PAOE008056P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist