Provider Demographics
NPI:1447319058
Name:WAGUESPACK, WENDY A (OD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:A
Last Name:WAGUESPACK
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 1:7932 PICARDY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3535
Mailing Address - Country:US
Mailing Address - Phone:225-767-8495
Mailing Address - Fax:225-767-9493
Practice Address - Street 1:7932 PICARDY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3535
Practice Address - Country:US
Practice Address - Phone:225-767-8495
Practice Address - Fax:225-767-9493
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA874019T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2468BOtherBLUE CROSS
LA1331139Medicaid
LA5777141OtherAETNA
LA5777141OtherAETNA
LAT19416Medicare UPIN