Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 294 | TN |
NPI | 1023290509 |
---|---|
Provider Name | Mr. Louis Daniel Pagano SR. |
First Address | Memphis, TN 38119-5202 |
Second Address | Memphis, TN 38119-5202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2007 |
Last Update Date | 27/11/2007 |