Healthcare Provider Details

I. General information

NPI: 1851381461
Provider Name (Legal Business Name): SAMUEL DAVID BIGLEY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 N CHESTNUT ST
SCOTTDALE PA
15683-1714
US

IV. Provider business mailing address

RR 2 BOX 70 HORNERTOWN ROAD
SCOTTDALE PA
15683-9504
US

V. Phone/Fax

Practice location:
  • Phone: 724-887-5820
  • Fax: 724-887-5825
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001536
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: