Individual provider Active NPI

Edward Steven Wygonik, O.D.

Optometrist
Saint Johns, FL

National Provider Identifier

1306819636

Registry record updated Jun 1, 2009

On this page

Key facts
NPPES NPI Registry
Medicare participation
National Provider Directory
Organizations & group practices1
NPI Registry JSON
Other providers in Saint Johns, FL
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: OptometristTaxonomy code 152W00000X
License: OPC 4250 Issued in FL
Practice address: 108 Drumellan CT
Saint Johns, FL 32259-7222
Phone: (412) 719-5926
NPI assigned: Feb 8, 2006
Last updated: Jun 1, 2009By the provider in NPPES
Sex: Male
Sole proprietor: Yes

NPPES NPI Registry

Updated by the provider on Jun 1, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 14

Specialty (taxonomy)	Code	License	State	Primary
Corneal and Contact Management Optometrist	152WC0802X	OPC 4250	FL
Pediatric Optometrist	152WP0200X	OPC 4250	FL
Sports Vision Optometrist	152WS0006X	OPC 4250	FL
Optometrist	152W00000X	OPC 4250	FL	Primary
Optometrist	152W00000X	OEG-000812	PA
Optometrist	152W00000X	5350/T2259	OH
Corneal and Contact Management Optometrist	152WC0802X	OEG-000812	PA
Corneal and Contact Management Optometrist	152WC0802X	5350/T2259	OH
Pediatric Optometrist	152WP0200X	OEG-000812	PA
Pediatric Optometrist	152WP0200X	5350/T2259	OH
Sports Vision Optometrist	152WS0006X	OEG-000812	PA
Sports Vision Optometrist	152WS0006X	5350/T2259	OH
Occupational Vision Optometrist	152WX0102X	OEG-000812	PA
Occupational Vision Optometrist	152WX0102X	5350/T2259	OH

Addresses

Primary practice location

108 Drumellan CT
Saint Johns, FL 32259-7222

Mailing address

108 Drumellan CT
Saint Johns, FL 32259-7222
Phone (412) 719-5926

Other identifiers 10

Identifier	Type	State	Issuer
50054	Other	PA	DAVIS VISION ID
WY1395963	Other	PA	BLUE CRSS/SHLD PROV ID
3002066	Other	PA	AETNA PROVIDER ID
220961	Other	PA	COLE MANAGED VISON ID
397597	Other	PA	NATIONAL VISION ADMIN. ID
1646983	Other	PA	HIGHMARK GROUP ID
220961	Other	PA	EYEMED ID
241675	Other	PA	HLTH AM/ASSR/ADVANTRA ID
101463734 0002	Medicaid	PA
313229	Other	PA	UPMC HEALTH PLAN ID

Medicare participation

Medicare enrollment files

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

Part B services: Yes
Medical equipment: Yes
Home health: Yes
Power mobility devices: No
Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Enrollment ID	State	Provider type	PAC ID	Details
I20090608000153	FL	Practitioner - Optometry	3577522499

National Provider Directory

Medicare enrollment (NPD): Enrolled

State licenses

License	State	Type	Specialty
5350/T2259	OH	MD	Optometrist
OPC 4250	FL	MD	Pediatric Optometrist
OEG-000812	PA	MD	Pediatric Optometrist

Practice roles

Organization	Specialty	Status	New patients
Fleming Island Vision Center	Optometrist	Past	Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Fleming Island Vision Center

dba Pearle Vision
- Optometrist
- Orange Park, FL
- NPI 1861668964
NPD (past)

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1243814400000",
    "number": "1306819636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 DRUMELLAN CT",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322597222",
            "telephone_number": "412-719-5926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 DRUMELLAN CT",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322597222",
            "telephone_number": "412-719-5926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYGONIK",
        "first_name": "EDWARD",
        "middle_name": "STEVEN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-08",
        "last_updated": "2009-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "FL",
            "license": "OPC 4250",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "FL",
            "license": "OPC 4250",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "",
            "desc": "Optometrist, Sports Vision",
            "state": "FL",
            "license": "OPC 4250",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 4250",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG-000812",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "5350/T2259",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "PA",
            "license": "OEG-000812",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "OH",
            "license": "5350/T2259",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "PA",
            "license": "OEG-000812",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "OH",
            "license": "5350/T2259",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "",
            "desc": "Optometrist, Sports Vision",
            "state": "PA",
            "license": "OEG-000812",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "",
            "desc": "Optometrist, Sports Vision",
            "state": "OH",
            "license": "5350/T2259",
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "",
            "desc": "Optometrist, Occupational Vision",
            "state": "PA",
            "license": "OEG-000812",
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "",
            "desc": "Optometrist, Occupational Vision",
            "state": "OH",
            "license": "5350/T2259",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVIS VISION ID",
            "identifier": "50054",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CRSS/SHLD PROV ID",
            "identifier": "WY1395963",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER ID",
            "identifier": "3002066",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLE MANAGED VISON ID",
            "identifier": "220961",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL VISION ADMIN. ID",
            "identifier": "397597",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK GROUP ID",
            "identifier": "1646983",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED ID",
            "identifier": "220961",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HLTH AM/ASSR/ADVANTRA ID",
            "identifier": "241675",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101463734 0002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPMC HEALTH PLAN ID",
            "identifier": "313229",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Johns, FL

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.