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General NPI Number Information
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NPI Number | 1689643561
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Entity Type | Individual
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Provider Name | THOMAS DANIEL JAGGER MD
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 08/02/2011
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Provider Practice Location Address
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Address Line | 150 BROAD ST
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City | WAVERLY
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State | NY
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Zip | 14892-1320
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Country | US
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Telephone | 607-565-2177
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Fax | 607-565-2064
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Provider Business Mailing Address
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Address Line | 1 GUTHRIE SQ
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City | SAYRE
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State | PA
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Zip | 18840-1625
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Country | US
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Telephone | 570-888-5858
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG000604
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV003009
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License Number State | NY
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