Provider Demographics
NPI:1710900451
Name:JAMES M. BUDD, O.D.
Entity Type:Organization
Organization Name:JAMES M. BUDD, O.D.
Other - Org Name:THE EYEGLASS STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUDD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:412-372-8188
Mailing Address - Street 1:4156 WM PENN HWY
Mailing Address - Street 2:MIRACLE MILE SHOPPING CENTER
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146
Mailing Address - Country:US
Mailing Address - Phone:412-372-8188
Mailing Address - Fax:412-372-8191
Practice Address - Street 1:4156 WILLIAM PENN HWY
Practice Address - Street 2:MIRACLE MILE SHOPPING CENTER
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146
Practice Address - Country:US
Practice Address - Phone:412-372-8188
Practice Address - Fax:412-372-8191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001177152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABU666231OtherBC/BS GROUP ID #
PABU666231OtherBC/BS GROUP ID #
PA0417830001Medicare NSC