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General NPI Number Information
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NPI Number | 1174549158
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Entity Type | Individual
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Provider Name | ROBERT DALE CAGNOLATTI OD
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Gender | Male
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 08/25/2010
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Provider Practice Location Address
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Address Line | 1812 ROSELAWN AVE
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City | MONROE
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State | LA
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Zip | 71201-5434
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Country | US
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Telephone | 318-387-9626
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Fax | 318-325-9425
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Provider Business Mailing Address
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Address Line | PO BOX 524
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City | DELHI
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State | LA
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Zip | 71232-0524
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Country | US
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Telephone | 318-450-0356
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 883-328T
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License Number State | LA
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