Provider Demographics
NPI:1659306330
Name:DUGUE, JAMES R (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:DUGUE
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 1:25982 PALA
Mailing Address - Street 2:SUITE 270
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6719
Mailing Address - Country:US
Mailing Address - Phone:949-951-1424
Mailing Address - Fax:949-770-5471
Practice Address - Street 1:25982 PALA
Practice Address - Street 2:SUITE 270
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6719
Practice Address - Country:US
Practice Address - Phone:949-951-1424
Practice Address - Fax:949-770-5471
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 7447 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0074470OtherMEDICAL PROVIDER #
CAOP7447Medicare ID - Type Unspecified
CAT70198Medicare UPIN