MEDICARE: GNO OPTICAL

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	016166	LA

General Provider Information

NPI Number	:	1770777492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GNO OPTICAL

Provider Business Mailing Address
First Line	:	4201 FRENCHMEN ST
Second Line	:	SUITE 1
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-3839
Country	:	US
Telephone Number	:	504-284-5780
Fax Number	:	504-282-7657

Provider Business Practice Location Address
First Line	:	4201 FRENCHMEN ST
Second Line	:	SUITE 1
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-3839
Country	:	US
Telephone Number	:	504-284-5780
Fax Number	:	504-282-7657

Authorized Official
Title or Position	:	OWNER
Name	:	GLEN CHARLES CANGELOSI
Credential	:	MD
Telephone Number	:	504-284-5780

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	09/06/2007

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Directions to “GNO OPTICAL ” Practice Location

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