Provider Demographics
NPI:1093790701
Name:PEDIGO, DAVID J (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:PEDIGO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:222 SW EVERETT MALL WAY
Mailing Address - Street 2:SUITE 11
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-2780
Mailing Address - Country:US
Mailing Address - Phone:425-645-1548
Mailing Address - Fax:425-328-1254
Practice Address - Street 1:1515 E TUDOR RD
Practice Address - Street 2:STE 5
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1035
Practice Address - Country:US
Practice Address - Phone:425-645-1548
Practice Address - Fax:425-328-1254
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOD00003590152W00000X
AK277152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMP1202679OtherDEA
WAU85175Medicare UPIN
WAAB18540Medicare ID - Type Unspecified