MEDICARE: NOEL L ELGUT MD LAS OLAS EYE CENTER

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	207W00000X	Ophthalmology Physician	ME58120	FL

General Provider Information

NPI Number	:	1497994016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOEL L ELGUT MD LAS OLAS EYE CENTER

Provider Business Mailing Address
First Line	:	1800 E LAS OLAS BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2444
Country	:	US
Telephone Number	:	954-463-4761
Fax Number	:	954-463-4763

Provider Business Practice Location Address
First Line	:	1800 E LAS OLAS BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2444
Country	:	US
Telephone Number	:	954-463-4761
Fax Number	:	954-463-4763

Authorized Official
Title or Position	:	OWNER
Name	:	NOEL ELGUT
Credential	:	MD
Telephone Number	:	954-463-4761

Provider Enumeration Date	:	02/05/2009
Last Update Date	:	07/16/2009

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