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General NPI Number Information
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NPI Number | 1306819636
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Entity Type | Individual
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Provider Name | EDWARD STEVEN WYGONIK O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 06/01/2009
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Provider Practice Location Address
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Address Line | 108 DRUMELLAN CT
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City | SAINT JOHNS
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State | FL
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Zip | 32259-7222
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Country | US
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Telephone | 412-719-5926
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Fax |
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Provider Business Mailing Address
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Address Line | 108 DRUMELLAN CT
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City | SAINT JOHNS
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State | FL
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Zip | 32259-7222
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Country | US
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Telephone | 412-719-5926
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | OPC 4250
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | OPC 4250
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number | OPC 4250
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC 4250
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG-000812
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License Number State | PA
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Taxonomy #6
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5350/T2259
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License Number State | OH
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Taxonomy #7
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | OEG-000812
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License Number State | PA
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Taxonomy #8
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 5350/T2259
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License Number State | OH
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Taxonomy #9
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | OEG-000812
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License Number State | PA
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Taxonomy #10
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 5350/T2259
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License Number State | OH
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Taxonomy #11
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number | OEG-000812
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License Number State | PA
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Taxonomy #12
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number | 5350/T2259
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License Number State | OH
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Taxonomy #13
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Taxonomy Code | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number | OEG-000812
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License Number State | PA
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Taxonomy #14
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Taxonomy Code | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number | 5350/T2259
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License Number State | OH
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