MEDICARE: DR. ROBERT DALE CAGNOLATTI OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	883-328T	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174549158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT DALE CAGNOLATTI OD

Provider Business Mailing Address
First Line	:	PO BOX 524
Second Line	:
City	:	DELHI
State	:	LA
Zip	:	71232-0524
Country	:	US
Telephone Number	:	318-450-0356
Fax Number	:

Provider Business Practice Location Address
First Line	:	1812 ROSELAWN AVE
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-5434
Country	:	US
Telephone Number	:	318-387-9626
Fax Number	:	318-325-9425

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	08/25/2010

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