Provider Demographics
NPI:1043393549
Name:PAGAN, MIGUEL A (OD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:A
Last Name:PAGAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:MIGUEL
Other - Middle Name:A
Other - Last Name:PAGAN-SANTANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:CIUDAD PRIMAVERA
Mailing Address - Street 2:1003 CALLE BOGOTA
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-8503
Mailing Address - Country:US
Mailing Address - Phone:787-360-7873
Mailing Address - Fax:
Practice Address - Street 1:CIUDAD PRIMAVERA
Practice Address - Street 2:1003 CALLE BOGOTA
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-8503
Practice Address - Country:US
Practice Address - Phone:787-360-7873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2001552152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist