Healthcare Provider Details

I. General information

NPI: 1265355358
Provider Name (Legal Business Name): HAILEY BUEGELER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4413 LYONS RD STE 101
COCONUT CREEK FL
33073-4383
US

IV. Provider business mailing address

5700 TOSCANA PL APT 206
MARGATE FL
33063-8055
US

V. Phone/Fax

Practice location:
  • Phone: 954-975-9181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7045
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: