Healthcare Provider Details

I. General information

NPI: 1366586497
Provider Name (Legal Business Name): JOSEPH RICHARD WOODLEY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 REVCO RD
SOMERSET PA
15501-7726
US

IV. Provider business mailing address

103 BRADFORD SQUARE DR
TRAFFORD PA
15085-1250
US

V. Phone/Fax

Practice location:
  • Phone: 412-860-9874
  • Fax: 814-443-0590
Mailing address:
  • Phone: 412-860-9874
  • Fax: 814-443-0590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOEG000197
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier01887557
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier6175207
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCIGNA
# 3
Identifier051407
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUMWA
# 4
Identifier1349779
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPA BC BS
# 5
Identifier311352
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUPMC
# 6
Identifier1531122
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGATEWAY HEALTH PLAN
# 7
Identifier410047141
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPA RAILROAD MEDICARE
# 8
IdentifierU87145
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHEALTH AMERICA ADVANTRA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: