Provider Demographics
NPI:1386792836
Name:PAVEGLIO, CAROLE ANN (OD)
Entity type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:ANN
Last Name:PAVEGLIO
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 1:5016 WAVEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-1362
Mailing Address - Country:US
Mailing Address - Phone:248-685-1750
Mailing Address - Fax:
Practice Address - Street 1:45075 W PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-1257
Practice Address - Country:US
Practice Address - Phone:248-960-5600
Practice Address - Fax:248-960-8049
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003026152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMP1219725OtherDEA NUMBER
MI1007150001Medicare NSC
MIU34853Medicare UPIN
MIMP1219725OtherDEA NUMBER