Provider Demographics
NPI:1598779043
Name:MAGGS, R JAMES (OD)
Entity Type:Individual
Prefix:
First Name:R
Middle Name:JAMES
Last Name:MAGGS
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 1:2414A TEXAS AVE S
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-4634
Mailing Address - Country:US
Mailing Address - Phone:979-764-0009
Mailing Address - Fax:979-764-7715
Practice Address - Street 1:2414A TEXAS AVE S
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-4634
Practice Address - Country:US
Practice Address - Phone:979-764-0009
Practice Address - Fax:979-764-7715
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02481T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0281160001OtherCIGNA GOVERNMENT SERVICES
TX093607202Medicaid
TX16060OtherSPECTERA
TX00E07FOtherBLUE CROSS BLUE SHIELD
TX16060OtherSPECTERA
TX0281160001OtherCIGNA GOVERNMENT SERVICES
TX742367304OtherTIN
TX8C6747/00459XMedicare ID - Type UnspecifiedMEDICARE PART B
TX0281160001Medicare NSC