Provider Demographics
NPI:1508876186
Name:MAGRO, MICHAEL F (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:F
Last Name:MAGRO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:F
Other - Last Name:MAGRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:929 PENN ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601
Mailing Address - Country:US
Mailing Address - Phone:610-376-7872
Mailing Address - Fax:610-376-4476
Practice Address - Street 1:929 PENN ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601
Practice Address - Country:US
Practice Address - Phone:610-376-7872
Practice Address - Fax:610-376-4476
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE007045T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1174499Medicaid
T87966Medicare UPIN
PA1174499Medicaid