MEDICARE: VIRGIL OGLE

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	237700000X	Hearing Instrument Specialist	AS4851	FL

General Provider Information

NPI Number	:	1841621182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGIL OGLE

Provider Business Mailing Address
First Line	:	1106 W NEW HAVEN AVE
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32904-4056
Country	:	US
Telephone Number	:	321-914-0810
Fax Number	:	321-914-0821

Provider Business Practice Location Address
First Line	:	1106 W NEW HAVEN AVE
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32904-4056
Country	:	US
Telephone Number	:	321-914-0810
Fax Number	:	321-914-0821

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

Provider Enumeration Date	:	12/12/2013
Last Update Date	:	12/12/2013

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