Provider Demographics
NPI:1164727434
Name:PAGANO, JAMES (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:PAGANO
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10041 US HIGHWAY 19 STE A
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-3785
Mailing Address - Country:US
Mailing Address - Phone:727-868-0780
Mailing Address - Fax:
Practice Address - Street 1:10041 US HIGHWAY 19 STE A
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-3785
Practice Address - Country:US
Practice Address - Phone:727-868-0780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1891156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician