Provider Demographics
NPI:1235138561
Name:PAGAN, RICHARD H (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:PAGAN
Suffix:
Gender:M
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:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-0949
Mailing Address - Country:US
Mailing Address - Phone:845-744-2003
Mailing Address - Fax:845-744-6260
Practice Address - Street 1:70 MAIN ST.
Practice Address - Street 2:
Practice Address - City:PINE BUSH
Practice Address - State:NY
Practice Address - Zip Code:12566
Practice Address - Country:US
Practice Address - Phone:845-744-2003
Practice Address - Fax:845-744-6260
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006249-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U84726Medicare UPIN
NYC148C2Medicare ID - Type Unspecified