Healthcare Provider Details

I. General information

NPI: 1750428561
Provider Name (Legal Business Name): ROGER PAEZ O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 GOODLETTE-FRANK RD N UNIT 200
NAPLES FL
34103-4607
US

IV. Provider business mailing address

12731 NEW BRITTANY BLVD
FORT MYERS FL
33907-3632
US

V. Phone/Fax

Practice location:
  • Phone: 239-418-0999
  • Fax:
Mailing address:
  • Phone: 239-418-0999
  • Fax: 239-418-0091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC5150
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number507
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: