Provider Demographics
NPI:1043422470
Name:DIGGINS, SHELLEY RENEE (OD)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:RENEE
Last Name:DIGGINS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 PAMELA DR
Mailing Address - Street 2:
Mailing Address - City:LOWER BURRELL
Mailing Address - State:PA
Mailing Address - Zip Code:15068-2711
Mailing Address - Country:US
Mailing Address - Phone:724-335-0640
Mailing Address - Fax:
Practice Address - Street 1:1101 FREEPORT RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-3103
Practice Address - Country:US
Practice Address - Phone:412-782-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000993152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0073090960002Medicaid
567818Medicare UPIN
PA001523Medicare ID - Type Unspecified