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General NPI Number Information
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NPI Number | 1124296967
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Entity Type | Organization
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Legal Business Name | EUGENE I BOGAGE OPTOMETRY
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Dates
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Enumeration Date | 02/14/2008
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Last Update Date | 03/19/2008
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Provider Practice Location Address
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Address Line | 1464 RT 61 SOUTH
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City | POTTSVILLE
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State | PA
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Zip | 17901-0749
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Country | US
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Telephone | 570-385-5446
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Fax | 570-385-5517
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Provider Business Mailing Address
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Address Line | PO BOX 749 1464 RT 61 SOUTH
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City | POTTSVILLE
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State | PA
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Zip | 17901-0749
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Country | US
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Telephone | 570-385-5446
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Fax | 570-385-5517
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Authorized Official
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Title or Position | OWNER
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Name | MR. EUGENE J BOGAGE
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Credential | OD
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Telephone | 570-385-5446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3728
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License Number State | PA
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