Basic Information
| Provider Information | |||||||||
| NPI: | 1396926424 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WIGTON | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | HUNT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3990 N ILLINOIS ST | ||||||||
| Address2: | |||||||||
| City: | SWANSEA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622261919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182771130 | ||||||||
| FaxNumber: | 6182774917 | ||||||||
| Practice Location | |||||||||
| Address1: | 3990 N ILLINOIS ST | ||||||||
| Address2: | |||||||||
| City: | SWANSEA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622261919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182771130 | ||||||||
| FaxNumber: | 6182774917 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2007 | ||||||||
| LastUpdateDate: | 07/27/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 29048 | AL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 051117260 | 01 | AL | BCBS | OTHER | 128667 | 05 | AL | MEDICAID | 051117254 | 01 | AL | BCBS | OTHER | 128661 | 05 | AL | MEDICAID | 051117258 | 01 | AL | BCBS | OTHER | 07805726 | 05 | MS | MEDICAID | 128645 | 05 | AL | MEDICAID | 051117262 | 01 | AL | BCBS | OTHER | 051117253 | 01 | AL | BCBS | OTHER | 051117259 | 01 | AL | BCBS | OTHER | 128646 | 05 | AL | MEDICAID | 128662 | 05 | AL | MEDICAID | 128660 | 05 | AL | MEDICAID |