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General NPI Number Information
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NPI Number | 1922100056
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Entity Type | Individual
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Provider Name | SHELLEY I GOGEL L.D.O.
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Gender | Female
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | 1311 LYONS RD
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City | COCONUT CREEK
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State | FL
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Zip | 33063-3927
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Country | US
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Telephone | 954-972-9393
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Fax | 954-979-9303
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Provider Business Mailing Address
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Address Line | 1311 LYONS RD
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City | COCONUT CREEK
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State | FL
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Zip | 33063-3927
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Country | US
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Telephone | 954-972-9393
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Fax | 954-979-9303
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | DO-4618
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License Number State | FL
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