Provider Demographics
NPI:1114991650
Name:WIGTON, JEFFREY S (OD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:WIGTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HOLLYWOOD DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-7604
Mailing Address - Country:US
Mailing Address - Phone:724-283-3500
Mailing Address - Fax:724-283-3269
Practice Address - Street 1:120 HOLLYWOOD DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-7604
Practice Address - Country:US
Practice Address - Phone:724-283-3500
Practice Address - Fax:724-283-3269
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000443152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA410015499OtherRAILROAD MEDICARE
PA410015499OtherRAILROAD MEDICARE
PA097865Medicare PIN