MEDICARE: DR. RICKY DEAN SCOGIN 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	LA1023144T	LA

General Provider Information

NPI Number	:	1811003916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICKY DEAN SCOGIN O.D.

Provider Business Mailing Address
First Line	:	2704 W DEBORAH DR
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-2002
Country	:	US
Telephone Number	:	318-387-3651
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 GLENWOOD DR
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-5501
Country	:	US
Telephone Number	:	318-322-6038
Fax Number	:	318-322-5217

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/08/2007

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