MEDICARE: MPG LLC

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		VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912029786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MPG LLC

Provider Business Mailing Address
First Line	:	1870 RESERVOIR ST
Second Line	:
City	:	HARRISONBURG
State	:	VA
Zip	:	22801
Country	:	US
Telephone Number	:	540-434-6622
Fax Number	:	540-434-4187

Provider Business Practice Location Address
First Line	:	1870 RESERVOIR ST
Second Line	:
City	:	HARRISONBURG
State	:	VA
Zip	:	22801-8742
Country	:	US
Telephone Number	:	540-434-6622
Fax Number	:	540-434-4187

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL P GOWEN SR.
Credential	:	OD
Telephone Number	:	540-434-6622

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	01/12/2010

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Directions to “MPG LLC ” Practice Location

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