Provider Demographics
NPI:1770559866
Name:WIGTON EYE CARE ASSOCIATES, INC
Entity type:Organization
Organization Name:WIGTON EYE CARE ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:I
Authorized Official - Last Name:BABLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-283-3500
Mailing Address - Street 1:120 HOLLYWOOD DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-7604
Mailing Address - Country:US
Mailing Address - Phone:724-283-3500
Mailing Address - Fax:724-283-3269
Practice Address - Street 1:120 HOLLYWOOD DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-7604
Practice Address - Country:US
Practice Address - Phone:724-283-3500
Practice Address - Fax:724-283-3269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA152W00000X152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0247770001Medicare NSC
PA160581Medicare PIN