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NPI Code Detail

MEDICARE: PAGAL OPTICAL, INC.

MEDICARE: PAGAL OPTICAL, INC.
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
1156FX1800XOptician4996NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1102136OTHERNYEYEMED
2FAO139OTHERNYPREFERRED CARE

General Provider Information

NPI Number : 1306933460
Entity Type Code : Organization
Provider Name (Legal Business Name) : PAGAL OPTICAL, INC.
Provider Business Mailing Address
First Line : 3349 MONROE AVE
Second Line : PITTSFORD PLAZA
City : ROCHESTER
State : NY
Zip : 14618-5513
Country : US
Telephone Number : 585-381-1616
Fax Number : 585-381-0718
Provider Business Practice Location Address
First Line : 3349 MONROE AVE
Second Line : PITTSFORD PLAZA
City : ROCHESTER
State : NY
Zip : 14618-5513
Country : US
Telephone Number : 585-381-1616
Fax Number : 585-381-0718
Authorized Official
Title or Position : OWNER
Name : MR. SELES A VARIN
Credential : O.D.
Telephone Number : 585-381-1616
Provider Enumeration Date : 10/09/2006
Last Update Date : 08/22/2020

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