Healthcare Provider Details

I. General information

NPI: 1568468106
Provider Name (Legal Business Name): STEPHEN ANDREW WIGGINTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 E ANAHEIM ST
LONG BEACH CA
90813-3507
US

IV. Provider business mailing address

709 E ANAHEIM ST
LONG BEACH CA
90813-3507
US

V. Phone/Fax

Practice location:
  • Phone: 562-591-7700
  • Fax: 562-591-1311
Mailing address:
  • Phone: 562-859-7700
  • Fax: 562-591-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA62061
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberA62061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: