Provider Demographics
NPI:1861555393
Name:MAGGIANO, JAMES VINCENT (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:VINCENT
Last Name:MAGGIANO
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 1:16801 S BELLFLOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706
Mailing Address - Country:US
Mailing Address - Phone:562-867-4220
Mailing Address - Fax:562-920-4375
Practice Address - Street 1:16801 S BELLFLOWER BLVD
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706
Practice Address - Country:US
Practice Address - Phone:562-867-4220
Practice Address - Fax:562-920-4375
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8794T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1024040001OtherMEDICARE MATERIALS
CASD0087940OtherMEDICAL
CA5239723Medicaid
OP8697Medicare ID - Type Unspecified
CA1024040001OtherMEDICARE MATERIALS