MEDICARE: DR. ROBIN L SCOGGIN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT001029	GA

General Provider Information

NPI Number	:	1346406717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBIN L SCOGGIN O.D.

Provider Business Mailing Address
First Line	:	203 GLEN MILNER BLVD
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30161-3239
Country	:	US
Telephone Number	:	706-378-3000
Fax Number	:	706-378-3087

Provider Business Practice Location Address
First Line	:	203 GLEN MILNER BLVD
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30161-3239
Country	:	US
Telephone Number	:	706-378-3000
Fax Number	:	706-378-3087

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	08/05/2008

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