MEDICARE: NICOLE DIANE LIGGETT OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG000498	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154405447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE DIANE LIGGETT OD

Provider Business Mailing Address
First Line	:	4960 WILLIAM FLYNN HWY
Second Line	:
City	:	ALLISON PARK
State	:	PA
Zip	:	15101-2354
Country	:	US
Telephone Number	:	724-443-5060
Fax Number	:

Provider Business Practice Location Address
First Line	:	4960 WILLIAM FLYNN HWY
Second Line	:
City	:	ALLISON PARK
State	:	PA
Zip	:	15101-2354
Country	:	US
Telephone Number	:	724-443-5060
Fax Number	:	724-443-5066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	05/26/2010

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