Healthcare Provider Details

I. General information

NPI: 1174764963
Provider Name (Legal Business Name): DAVID L. NAUGLE, OD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2009
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

991 E CHESTNUT ST
HAZLETON PA
18201-6807
US

V. Phone/Fax

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

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: TAMI ANN BINDAS
Title or Position: MANAGER
Credential:
Phone: 570-454-1860