MEDICARE: GERALDJ.D'AGOSTINO

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	332H00000X	Eyewear Supplier
2	152W00000X	Optometrist

General Provider Information

NPI Number	:	1730316340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERALDJ.D'AGOSTINO

Provider Business Mailing Address
First Line	:	150 MALLARD CREEK RUN
Second Line	:
City	:	LAGRANGE
State	:	OH
Zip	:	44050-9802
Country	:	US
Telephone Number	:	440-458-6272
Fax Number	:	440-458-6272

Provider Business Practice Location Address
First Line	:	5404 NORTHFIELD RD
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3113
Country	:	US
Telephone Number	:	216-587-6620
Fax Number	:	216-587-6623

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GERALD J D'AGOSTINO
Credential	:	OD
Telephone Number	:	216-587-6620

Provider Enumeration Date	:	06/22/2009
Last Update Date	:	06/22/2009

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Directions to “GERALDJ.D'AGOSTINO ” Practice Location

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