Provider Demographics
NPI:1366586497
Name:WOODLEY, JOSEPH RICHARD (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:RICHARD
Last Name:WOODLEY
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 1:103 BRADFORD SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:TRAFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15085-1250
Mailing Address - Country:US
Mailing Address - Phone:412-860-9874
Mailing Address - Fax:814-443-0590
Practice Address - Street 1:110 REVCO RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-7726
Practice Address - Country:US
Practice Address - Phone:412-860-9874
Practice Address - Fax:814-443-0590
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000197152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01887557Medicaid
PA6175207OtherCIGNA
PA051407OtherUMWA
PA1349779OtherPA BC BS
PA311352OtherUPMC
PA1531122OtherGATEWAY HEALTH PLAN
PA410047141OtherPA RAILROAD MEDICARE
PAU87145OtherHEALTH AMERICA ADVANTRA
PAU87145OtherHEALTH AMERICA ADVANTRA
PA01887557Medicaid