Provider Demographics
NPI:1124159660
Name:BAGUN, ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:BAGUN
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 1:10 STRATHMORE DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-7022
Mailing Address - Country:US
Mailing Address - Phone:845-356-2431
Mailing Address - Fax:
Practice Address - Street 1:2001 SOUTH RD # 206
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-5978
Practice Address - Country:US
Practice Address - Phone:845-298-1288
Practice Address - Fax:845-298-1280
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3835152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT89800Medicare UPIN