Provider Demographics
NPI:1710972005
Name:JAGELA, EDWARD J (OD, FAAO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:JAGELA
Suffix:
Gender:M
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 JOHNSON RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2356
Mailing Address - Country:US
Mailing Address - Phone:740-283-3937
Mailing Address - Fax:740-283-1858
Practice Address - Street 1:4100 JOHNSON RD
Practice Address - Street 2:SUITE 204
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2356
Practice Address - Country:US
Practice Address - Phone:740-283-3937
Practice Address - Fax:740-283-1858
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2019-05-16
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
OH4201/T497152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000213650OtherANTHEM BC/BS
WV0149838001Medicaid
WV1068565OtherBUR OF WC (BRICKSTREET)
OH0007520120OtherAETNA
OH0898953Medicaid
OH001720035OtherMOUNTAIN STATE BC/BS
OH0898953OtherCARESOURCE
OH4201T497OtherMEDICAL MUTUAL
OH1322660001Medicare NSC
OH0007520120OtherAETNA
OH0772517Medicare PIN
OH0898953OtherCARESOURCE