Provider Demographics
NPI:1144422361
Name:EDWARD J JAGELA OD FAAO
Entity type:Organization
Organization Name:EDWARD J JAGELA OD FAAO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:JAGELA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-283-3937
Mailing Address - Street 1:4100 JOHNSON RD STE 204
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2365
Mailing Address - Country:US
Mailing Address - Phone:740-283-3937
Mailing Address - Fax:740-283-1858
Practice Address - Street 1:4100 JOHNSON RD STE 204
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2365
Practice Address - Country:US
Practice Address - Phone:740-283-3937
Practice Address - Fax:740-283-1858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4201T497152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010122Medicaid
OH2188967Medicaid
OH001708312OtherMOUNTAIN STATE BCBS
OH23608815203OtherMEDICAL MUTUAL
OH000000205776OtherANTHEM BCBS
OH4201T497OtherAETNA
OH23608815203OtherMEDICAL MUTUAL
OH9308231Medicare PIN
OH001708312OtherMOUNTAIN STATE BCBS