MEDICARE: DR. JULIE A. PAGAN 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	152W00000X	Optometrist	TUV006235-1	NY

General Provider Information

NPI Number	:	1649279647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE A. PAGAN OD

Provider Business Mailing Address
First Line	:	PO BOX 949
Second Line	:
City	:	PINE BUSH
State	:	NY
Zip	:	12566-0949
Country	:	US
Telephone Number	:	845-744-2003
Fax Number	:	845-744-6260

Provider Business Practice Location Address
First Line	:	70 MAIN ST
Second Line	:
City	:	PINE BUSH
State	:	NY
Zip	:	12566-0949
Country	:	US
Telephone Number	:	845-744-2003
Fax Number	:	845-744-6260

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	08/10/2010

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