MEDICARE: DR. JACLYN ANN WADDELL 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	OEG003177	PA

General Provider Information

NPI Number	:	1801247614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACLYN ANN WADDELL O.D.

Provider Business Mailing Address
First Line	:	475 E BRUCETON RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15236-4503
Country	:	US
Telephone Number	:	412-892-9767
Fax Number	:	412-892-9768

Provider Business Practice Location Address
First Line	:	475 E BRUCETON RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15236-4503
Country	:	US
Telephone Number	:	412-892-9767
Fax Number	:	412-892-9768

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

Provider Enumeration Date	:	06/23/2016
Last Update Date	:	02/20/2024

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