Provider Demographics
NPI:1447254354
Name:REDDIG, MICHAEL DENNIS (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DENNIS
Last Name:REDDIG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:32 HUMMER RD
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1507
Mailing Address - Country:US
Mailing Address - Phone:717-733-0148
Mailing Address - Fax:717-733-3637
Practice Address - Street 1:32 HUMMER RD
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1507
Practice Address - Country:US
Practice Address - Phone:717-733-0148
Practice Address - Fax:717-733-3637
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000021152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU89583OtherHEALTH AMERICA
PA50034659OtherCAPITAL BLUE CROSS
PA231939118OtherVISION SERVICE PLAN
PAU85983OtherADVANTRA
PA231939118OtherHEALTH GUARD
PAU89583OtherHEALTH ASSURANCE
PA1325255OtherHIGHMARK BLUE SHIELD
PA231939118OtherVISION SERVICE PLAN
PAU89583OtherHEALTH AMERICA