Dr Bret Bouton Wagenhorst, MD | |
1803 Old Ocilla Rd, Tifton, GA 31794-1617 | |
(229) 386-2181 | |
(229) 386-2193 |
Full Name | Dr Bret Bouton Wagenhorst |
---|---|
Gender | Male |
Speciality | Ophthalmology |
Experience | 36 Years |
Location | 1803 Old Ocilla Rd, Tifton, Georgia |
Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1841201134 | NPI | - | NPPES |
077471001 | Other | GA | CIGNA |
00760856A | Medicaid | GA | |
180041335 | Other | GA | RRMC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207W00000X | Ophthalmology | 044138 (Georgia) | Primary |
Facility Name | Location | Facility Type |
---|---|---|
Tift Regional Medical Center | Tifton, GA | Hospital |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
Tift Regional Health System Inc | 2062745169 | 278 |
Entity Name | Tift Regional Health System, Inc. |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1790280857 PECOS PAC ID: 5193619971 Enrollment ID: O20040212000064 |
Entity Name | Tift Regional Health System Inc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1881203305 PECOS PAC ID: 2062745169 Enrollment ID: O20200217002409 |
Mailing Address | Practice Location Address |
---|---|
Dr Bret Bouton Wagenhorst, MD 907 18th St E Ste 400, Tifton, GA 31794-3684 Ph: (229) 353-3450 | Dr Bret Bouton Wagenhorst, MD 1803 Old Ocilla Rd, Tifton, GA 31794-1617 Ph: (229) 386-2181 |
Dr. Robert Jon Holme, M.D. Ophthalmology Medicare: Medicare Enrolled Practice Location: 1803 Old Ocilla Rd, Tifton, GA 31794 Phone: 229-386-2181 Fax: 229-386-2193 | |
Dr. Larry Russell Moorman, M.D. Ophthalmology Medicare: Not Enrolled in Medicare Practice Location: 1803 Old Ocilla Rd, Tifton, GA 31794 Phone: 229-386-2181 Fax: 229-386-2193 |