Healthcare Provider Details

I. General information

NPI: 1033152137
Provider Name (Legal Business Name): DAVID L NAUGLE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 E CHESTNUT ST
HAZLETON PA
18201-6807
US

IV. Provider business mailing address

2028 FATHER ANGELO DRIVE
HAZLE TWP PA
18202
US

V. Phone/Fax

Practice location:
  • Phone: 570-454-1860
  • Fax: 570-454-1898
Mailing address:
  • Phone: 570-454-1860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001613
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0018193500005
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: