MEDICARE: STEPHEN MARK JAGGI OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	152W00000X	Optometrist	0003131	CO

General Provider Information

NPI Number	:	1538411871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN MARK JAGGI OD

Provider Business Mailing Address
First Line	:	PSC 477 BOX 2
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96306-0001
Country	:	US
Telephone Number	:	315-264-4696
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 477 BOX 2
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96306-0001
Country	:	US
Telephone Number	:	315-264-4696
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2012
Last Update Date	:	08/04/2025

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