Basic Information
| Provider Information | |||||||||
| NPI: | 1609820190 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ORWIG | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 509 | ||||||||
| Address2: | |||||||||
| City: | HUMBOLDT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383430509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316350991 | ||||||||
| FaxNumber: | 7316357372 | ||||||||
| Practice Location | |||||||||
| Address1: | 2439 N CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | HUMBOLDT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383431753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7317841186 | ||||||||
| FaxNumber: | 7317840601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 11/05/2018 | ||||||||
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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 | 152W00000X | OD1496 | TN | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 32098 | 01 | TN | TLC MEMPHIS MANAGED CARE | OTHER | 9491076 | 01 | CIGNA HEALTHCARE | OTHER | 10023282 | 01 | VESTICA HEALTH PLAN | OTHER | 3946215 | 05 | TN | MEDICAID | 4105805 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER |