Provider Demographics
NPI:1205827912
Name:CALDWELL, GREGORY A (OD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:CALDWELL
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 1:108 OLDE FARM OFFICE RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-9417
Mailing Address - Country:US
Mailing Address - Phone:814-695-3141
Mailing Address - Fax:814-696-4780
Practice Address - Street 1:108 OLDE FARM OFFICE RD
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-9417
Practice Address - Country:US
Practice Address - Phone:814-695-3141
Practice Address - Fax:814-696-4780
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000024152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410031702OtherRR MEDICARE INDIVIDUAL
PA0016242600017Medicaid
410031702OtherRR MEDICARE INDIVIDUAL
PA0016242600017Medicaid