Provider Demographics
NPI:1336145812
Name:DENNIS A REDDIG OD & MICHAEL D REDDIG OD
Entity Type:Organization
Organization Name:DENNIS A REDDIG OD & MICHAEL D REDDIG OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:REDDIG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-733-0148
Mailing Address - Street 1:32 HUMMER RD
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1507
Mailing Address - Country:US
Mailing Address - Phone:717-733-0148
Mailing Address - Fax:717-733-3637
Practice Address - Street 1:32 HUMMER RD
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1507
Practice Address - Country:US
Practice Address - Phone:717-733-0148
Practice Address - Fax:717-733-3637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA231939118152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2524000OtherCAPITAL BLUE CROSS
PA231939118OtherVISION SERVICE PLAN
PARE1599308OtherHIGHMARK BLUE SHIELD
PA231939118OtherHEALTHAMERICA/HEALTHASSUR
0304100001OtherDME, NSC
PA231939118OtherHEALTHGUARD
PA231939118OtherHEALTHGUARD
PA2524000OtherCAPITAL BLUE CROSS