Provider Demographics
NPI:1467811018
Name:WIGGS, DONALD S (LDO)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:S
Last Name:WIGGS
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8116 BETHLEHEM RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-2704
Mailing Address - Country:US
Mailing Address - Phone:302-384-3216
Mailing Address - Fax:571-406-5043
Practice Address - Street 1:7771 ASHTON AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2879
Practice Address - Country:US
Practice Address - Phone:571-393-1443
Practice Address - Fax:571-406-5043
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101003676156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADWIGGS7771Medicaid
VA1234567890Medicare UPIN
VA1234567890Medicare NSC
VA1234567890Medicare PIN
VA1234567890Medicare Oscar/Certification