Provider Demographics
NPI:1518983279
Name:HIGLEY, DAVID G (OD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:G
Last Name:HIGLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1700 S PARK
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001
Mailing Address - Country:US
Mailing Address - Phone:269-342-0003
Mailing Address - Fax:269-342-4284
Practice Address - Street 1:3576 ALPINE AVE NW
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MI
Practice Address - Zip Code:49504-1659
Practice Address - Country:US
Practice Address - Phone:616-784-4999
Practice Address - Fax:269-342-4284
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4901002414152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0733500012Medicare NSC
T33041Medicare UPIN
MI0C97655070Medicare PIN