Provider Demographics
NPI:1568452043
Name:WANAGAT, ERICH WILLIAM (OD)
Entity type:Individual
Prefix:DR
First Name:ERICH
Middle Name:WILLIAM
Last Name:WANAGAT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-1542
Mailing Address - Country:US
Mailing Address - Phone:580-213-7418
Mailing Address - Fax:
Practice Address - Street 1:527 GOTT
Practice Address - Street 2:
Practice Address - City:VANCE AFB
Practice Address - State:OK
Practice Address - Zip Code:73703
Practice Address - Country:US
Practice Address - Phone:580-213-6171
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003373A152W00000X
IN18003373B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist