Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1891 | FL |
NPI | 1164727434 |
---|---|
Provider Name | James Pagano |
First Address | Port Richey, FL 34668-3785 |
Second Address | Port Richey, FL 34668-3785 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2011 |
Last Update Date | 31/01/2011 |