Healthcare Provider Details

I. General information

NPI: 1932397593
Provider Name (Legal Business Name): DR. JOSEPH R. WOODLEY, O.D. & ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 VILLAGE CENTER DRIVE
TARENTUM PA
15084
US

IV. Provider business mailing address

157 NASSAU DR
PITTSBURGH PA
15239-2138
US

V. Phone/Fax

Practice location:
  • Phone: 412-860-9874
  • Fax: 724-274-1750
Mailing address:
  • Phone: 412-860-9874
  • Fax: 724-274-1750

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

VIII. Authorized Official

Name: DR. JOSEPH RICHARD WOODLEY
Title or Position: PRESIDENT
Credential: OD
Phone: 412-860-9874