Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 6003T | TX |
NPI | 1013086362 |
---|---|
Provider Name | Dr. Ardith Renee Pagan |
First Address | Austin, TX 78758-4444 |
Second Address | Austin, TX 78758-4444 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 13/04/2016 |