Provider Demographics
NPI:1538238787
Name:CANGIANO, PAUL M (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:CANGIANO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 STILLMAN ST
Mailing Address - Street 2:UNIT 5-3
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02113-1695
Mailing Address - Country:US
Mailing Address - Phone:508-561-8841
Mailing Address - Fax:617-227-1997
Practice Address - Street 1:77 N WASHINGTON ST
Practice Address - Street 2:VISION NORTH
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-1908
Practice Address - Country:US
Practice Address - Phone:617-227-2010
Practice Address - Fax:617-227-1997
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3947152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0371301Medicaid
MAU62669Medicare UPIN
MA0371301Medicaid
MAW21087Medicare ID - Type UnspecifiedGROUP