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General NPI Number Information
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NPI Number | 1942483144
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Entity Type | Organization
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Legal Business Name | JAMES D HAGEN OD PA
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 12979 SW 112TH ST
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City | MIAMI
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State | FL
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Zip | 33186-4769
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Country | US
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Telephone | 305-386-3937
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Fax | 305-386-1492
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Provider Business Mailing Address
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Address Line | 12979 SW 112TH ST
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City | MIAMI
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State | FL
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Zip | 33186-4769
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Country | US
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Telephone | 305-386-3937
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Fax | 305-386-1492
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES D HAGEN
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Credential |
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Telephone | 305-386-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC 001745
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License Number State | FL
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