Individual
DR. THOMAS DANIEL JAGGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
150 BROAD ST, WAVERLY, NY 14892-1320
(607) 565-2177
(607) 565-2064
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OEG000604
PA
152W00000X
Optometrist
Primary
TUV003009
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001844952001
—
PA
05
—
02144190
—
NY
01
—
410045675
RR MEDICARE PIN
NY
01
—
CC8362
RR MEDICARE GROUP
NY
Enumeration date
03/14/2006
Last updated
08/02/2011
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