Healthcare Provider Details

I. General information

NPI: 1174549158
Provider Name (Legal Business Name): ROBERT DALE CAGNOLATTI OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 ROSELAWN AVE
MONROE LA
71201-5434
US

IV. Provider business mailing address

PO BOX 524
DELHI LA
71232-0524
US

V. Phone/Fax

Practice location:
  • Phone: 318-387-9626
  • Fax: 318-325-9425
Mailing address:
  • Phone: 318-450-0356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number883-328T
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: