Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Thomas Jeffrey Wagner, ODMS

Individual provider Optometrist · NPI 1114993789

Dr. Thomas Jeffrey Wagner, ODMS is an Optometry in Mystic, Connecticut. Graduated from Pennsylvania College of Optometry in 1990, 36 years ago. Accepts Medicare assignment. Licensed in Connecticut.

Years since qualifying
36
Trained at
Pennsylvania College of Optometry
Licensed in
CT
In the registry since
2006

Practice location Address checks out

12 Roosevelt Ave
Mystic, CT 06355-2809
Phone: (860) 536-1313
Fax: (860) 572-7770
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Optometrist (primary) Taxonomy 152W00000X · Licence 002282 (CT)

Record details

NPI number1114993789
Entity typeIndividual (Type 1)
GenderMale
Credentials ODMS
Sole proprietorNo
NPI enumeratedFebruary 24, 2006
Last updated in NPPESMarch 24, 2020
Certification dateMarch 24, 2020
Mailing address540 Route 148, Killingworth, CT 06419-1107

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOPTOMETRY
Medical schoolPENNSYLVANIA COLLEGE OF OPTOMETRY
Graduated 1990 (36 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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