Provider Demographics
NPI:1629064241
Name:WOJTON, MICHAEL DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:WOJTON
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 1:5 BYRON LN
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-3223
Mailing Address - Country:US
Mailing Address - Phone:215-428-2122
Mailing Address - Fax:
Practice Address - Street 1:85 MAKEFIELD RD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5967
Practice Address - Country:US
Practice Address - Phone:215-295-0444
Practice Address - Fax:215-295-6161
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001050152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
918900OtherEYE MED
3746376OtherAETNA
U77250Medicare UPIN
W0031989Medicare ID - Type Unspecified