Provider Demographics
NPI:1447774955
Name:PAEZ & YONTZ OD PA
Entity Type:Organization
Organization Name:PAEZ & YONTZ OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:PAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-860-2144
Mailing Address - Street 1:3645 SANTAREN CT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-8661
Mailing Address - Country:US
Mailing Address - Phone:702-860-2144
Mailing Address - Fax:
Practice Address - Street 1:2628 TAMIAMI TRL N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4409
Practice Address - Country:US
Practice Address - Phone:239-649-8899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5150152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty