Provider Demographics
NPI:1184713018
Name:PAUL R. SIGLEY, OPTICIAN, INC.
Entity type:Organization
Organization Name:PAUL R. SIGLEY, OPTICIAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SIGLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:304-598-4888
Mailing Address - Street 1:1 STADIUM DRIVE
Mailing Address - Street 2:WVU EYE INSTITUTE
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-9193
Mailing Address - Country:US
Mailing Address - Phone:304-598-4888
Mailing Address - Fax:304-598-4191
Practice Address - Street 1:1 STADIUM DRIVE
Practice Address - Street 2:WVU EYE INSTITUTE
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-9193
Practice Address - Country:US
Practice Address - Phone:304-598-4888
Practice Address - Fax:304-598-4191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003574Medicaid
WV3810003574Medicaid
WV3810003574Medicaid
WV=========Medicare ID - Type UnspecifiedFEDERAL TAX ID NUMBER