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General NPI Number Information
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NPI Number | 1841409505
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Entity Type | Organization
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Legal Business Name | MICHAEL FOGT P A
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 900 SE OCEAN BLVD STE. 106A
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City | STUART
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State | FL
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Zip | 34994-2471
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Country | US
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Telephone | 772-287-2663
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Fax | 772-781-6797
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Provider Business Mailing Address
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Address Line | 900 SE OCEAN BLVD STE. 106A
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City | STUART
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State | FL
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Zip | 34994-2471
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Country | US
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Telephone | 772-287-2663
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Fax | 772-781-6797
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Authorized Official
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Title or Position | OPTOMETRIST SOLE PROPRIETOR
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Name | MICHAEL L FOGT
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Credential | O D
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Telephone | 772-287-2663
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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 | OPC980
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License Number State | FL
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