Individual
DR. EDWARD STEVEN WYGONIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
108 DRUMELLAN CT, SAINT JOHNS, FL 32259-7222
(412) 719-5926
Mailing address
108 DRUMELLAN CT, SAINT JOHNS, FL 32259-7222
(412) 719-5926
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
5350/T2259
OH
152W00000X
Optometrist
OEG-000812
PA
152W00000X
Optometrist
Primary
OPC 4250
FL
152WC0802X
Corneal and Contact Management Optometrist
5350/T2259
OH
152WC0802X
Corneal and Contact Management Optometrist
OEG-000812
PA
152WC0802X
Corneal and Contact Management Optometrist
OPC 4250
FL
152WP0200X
Pediatric Optometrist
5350/T2259
OH
152WP0200X
Pediatric Optometrist
OEG-000812
PA
152WP0200X
Pediatric Optometrist
OPC 4250
FL
152WS0006X
Sports Vision Optometrist
5350/T2259
OH
152WS0006X
Sports Vision Optometrist
OEG-000812
PA
152WS0006X
Sports Vision Optometrist
OPC 4250
FL
152WX0102X
Occupational Vision Optometrist
5350/T2259
OH
152WX0102X
Occupational Vision Optometrist
OEG-000812
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101463734 0002
—
PA
01
—
1646983
HIGHMARK GROUP ID
PA
01
—
220961
COLE MANAGED VISON ID
PA
01
—
241675
HLTH AM/ASSR/ADVANTRA ID
PA
01
—
3002066
AETNA PROVIDER ID
PA
01
—
313229
UPMC HEALTH PLAN ID
PA
01
—
397597
NATIONAL VISION ADMIN. ID
PA
01
—
50054
DAVIS VISION ID
PA
01
—
WY1395963
BLUE CRSS/SHLD PROV ID
PA
Enumeration date
02/08/2006
Last updated
06/01/2009
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