Provider Demographics
NPI:1477559573
Name:REDDIG, DENNIS A (OD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:A
Last Name:REDDIG
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 1:32 HUMMER RD
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1507
Mailing Address - Country:US
Mailing Address - Phone:717-733-0148
Mailing Address - Fax:717-733-3637
Practice Address - Street 1:32 HUMMER RD
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1507
Practice Address - Country:US
Practice Address - Phone:717-733-0148
Practice Address - Fax:717-733-3637
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000564152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28448OtherHEALTHAMERICA/HEATHASSURA
PA231939118OtherVISION SERVICE PLAN
PARE92611OtherHIGHMARK BLUE SHIELD
PAT28448OtherHEALTHGUARD
PA092611Medicare PIN
PA231939118OtherVISION SERVICE PLAN