MEDICARE: JAMES PAGANO OPTICIAN

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	156FX1800X	Optician	1891	FL

General Provider Information

NPI Number	:	1164727434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES PAGANO OPTICIAN

Provider Business Mailing Address
First Line	:	10041 US HIGHWAY 19 STE A
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-3785
Country	:	US
Telephone Number	:	727-868-0780
Fax Number	:

Provider Business Practice Location Address
First Line	:	10041 US HIGHWAY 19 STE A
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-3785
Country	:	US
Telephone Number	:	727-868-0780
Fax Number	:

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

Provider Enumeration Date	:	01/18/2011
Last Update Date	:	01/31/2011

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