Provider Demographics
NPI:1487340212
Name:WANNER, CAROLINE ELIZABETH (OD)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ELIZABETH
Last Name:WANNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8801 HORIZON BLVD NE STE 360
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1563
Mailing Address - Country:US
Mailing Address - Phone:505-246-2622
Mailing Address - Fax:505-715-5334
Practice Address - Street 1:8380 CERRILLOS RD STE 300
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4418
Practice Address - Country:US
Practice Address - Phone:505-375-8955
Practice Address - Fax:505-404-0795
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMOPT-2025-0015152W00000X
VA0618003248152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist