Provider Demographics
NPI:1376542449
Name:CAGE, DAVID JOHN (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:CAGE
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 1:2640 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-4524
Mailing Address - Country:US
Mailing Address - Phone:814-835-8258
Mailing Address - Fax:814-838-0104
Practice Address - Street 1:2640 W 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4524
Practice Address - Country:US
Practice Address - Phone:814-835-8258
Practice Address - Fax:814-838-0104
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001497152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1737799OtherBLUE CROSS
PADG8866OtherR.R. MEDICARE
PA089261Medicare PIN
PAV04325Medicare UPIN
PADG8866OtherR.R. MEDICARE
PA089261XSUMedicare UPIN