Provider Demographics
NPI:1124097068
Name:PAXMAN, PAUL A (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:PAXMAN
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 1:24 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2318
Mailing Address - Country:US
Mailing Address - Phone:801-756-7996
Mailing Address - Fax:
Practice Address - Street 1:24 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2318
Practice Address - Country:US
Practice Address - Phone:801-756-7996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT114252-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000062523Medicare PIN
UTU21503Medicare UPIN