MEDICARE: DR. ROGER LEE RENGEL O.D.

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	1622	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	65138	OTHER	MN	MEDICARE TAX ID
7	580000012	OTHER	MN	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	157859294	OTHER	MN	NPI NUMBER
2	21326	OTHER	MN	HEALTHPARTNERS
3	965040671001	OTHER	MN	PREFERRED ONE
4	SC1009	OTHER	MN	SELECT CARE
5	OB800RE	OTHER	MN	BLUE CROSS/ BLUE SHIELD
8	22-02741	OTHER	MN	MEDICA
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578595294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER LEE RENGEL O.D.

Provider Business Mailing Address
First Line	:	700 VILLAGE CENTER DR
Second Line	:	SUITE 180
City	:	NORTH OAKS
State	:	MN
Zip	:	55127-3019
Country	:	US
Telephone Number	:	651-482-1959
Fax Number	:	651-482-1850

Provider Business Practice Location Address
First Line	:	700 VILLAGE CENTER DR
Second Line	:	SUITE 180
City	:	NORTH OAKS
State	:	MN
Zip	:	55127-3019
Country	:	US
Telephone Number	:	651-482-1959
Fax Number	:	651-482-1850

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	12/12/2009

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Directions to “ DR. ROGER LEE RENGEL O.D.” Practice Location

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