Provider Demographics
NPI:1730397605
Name:PAGON, KATA (OD)
Entity type:Individual
Prefix:MRS
First Name:KATA
Middle Name:
Last Name:PAGON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14660 RINDLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NOVELTY
Mailing Address - State:OH
Mailing Address - Zip Code:44072-9590
Mailing Address - Country:US
Mailing Address - Phone:440-247-4632
Mailing Address - Fax:
Practice Address - Street 1:8900 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6345
Practice Address - Country:US
Practice Address - Phone:440-255-7727
Practice Address - Fax:440-255-4288
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHT303152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist