1306819636 NPI number — DR. EDWARD STEVEN WYGONIK O.D.

Table of content: DR. EDWARD STEVEN WYGONIK O.D. (NPI 1306819636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306819636 NPI number — DR. EDWARD STEVEN WYGONIK O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WYGONIK
Provider First Name:
EDWARD
Provider Middle Name:
STEVEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306819636
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 DRUMELLAN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT JOHNS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32259-7222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-719-5926
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 DRUMELLAN CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT JOHNS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32259-7222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-719-5926
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152WC0802X , with the licence number:  OPC 4250 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WP0200X , with the licence number: OPC 4250 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WS0006X , with the licence number: OPC 4250 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: OPC 4250 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: OEG-000812 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 5350/T2259 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WC0802X , with the licence number: OEG-000812 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WC0802X , with the licence number: 5350/T2259 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WP0200X , with the licence number: OEG-000812 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WP0200X , with the licence number: 5350/T2259 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WS0006X , with the licence number: OEG-000812 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WS0006X , with the licence number: 5350/T2259 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WX0102X , with the licence number: OEG-000812 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WX0102X , with the licence number: 5350/T2259 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50054 . This is a "DAVIS VISION ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: WY1395963 . This is a "BLUE CRSS/SHLD PROV ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3002066 . This is a "AETNA PROVIDER ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 220961 . This is a "COLE MANAGED VISON ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 397597 . This is a "NATIONAL VISION ADMIN. ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1646983 . This is a "HIGHMARK GROUP ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 220961 . This is a "EYEMED ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 241675 . This is a "HLTH AM/ASSR/ADVANTRA ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101463734 0002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 313229 . This is a "UPMC HEALTH PLAN ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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