Provider Demographics
NPI:1902880446
Name:BUDD, JAMES MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:BUDD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4156 WILLIAM PENN HWY.
Mailing Address - Street 2:THE EYEGLASS STORE
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146
Mailing Address - Country:US
Mailing Address - Phone:412-372-8188
Mailing Address - Fax:412-372-8191
Practice Address - Street 1:4156 WILLIAM PENN HWY.
Practice Address - Street 2:THE EYEGLASS STORE
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146
Practice Address - Country:US
Practice Address - Phone:412-372-8188
Practice Address - Fax:412-372-8191
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001177152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA666231Medicare PIN
PAU11636Medicare UPIN