Provider Demographics
NPI:1013008226
Name:PAGANI, JEAN MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:MARIE
Last Name:PAGANI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PARKVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-6318
Mailing Address - Country:US
Mailing Address - Phone:610-566-3903
Mailing Address - Fax:
Practice Address - Street 1:1200 W GODFREY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3323
Practice Address - Country:US
Practice Address - Phone:215-276-6000
Practice Address - Fax:215-276-6167
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI3-0001187152W00000X
PAOEG001178152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0115840000OtherKHPE
PA2248OtherAETNA HMO
PA0011944190003Medicaid
PA00061991OtherRAILROAD MEDICARE
PA539951OtherBLUE SHIELD
PA0011944190003Medicaid
PAU08264Medicare UPIN