MEDICARE: DR. DAVID ROY WIGGINS O.D.

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	3107TG	TX

General Provider Information

NPI Number	:	1346436334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ROY WIGGINS O.D.

Provider Business Mailing Address
First Line	:	PO BOX 461673
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78246-1673
Country	:	US
Telephone Number	:	210-337-1595
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 SW MILITARY DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221-1538
Country	:	US
Telephone Number	:	210-337-1595
Fax Number	:

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

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	09/24/2007

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