MEDICARE: MS. SHELLEY I GOGEL L.D.O.

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	156FX1800X	Optician	DO-4618	FL

General Provider Information

NPI Number	:	1922100056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHELLEY I GOGEL L.D.O.

Provider Business Mailing Address
First Line	:	1311 LYONS RD
Second Line	:
City	:	COCONUT CREEK
State	:	FL
Zip	:	33063-3927
Country	:	US
Telephone Number	:	954-972-9393
Fax Number	:	954-979-9303

Provider Business Practice Location Address
First Line	:	1311 LYONS RD
Second Line	:
City	:	COCONUT CREEK
State	:	FL
Zip	:	33063-3927
Country	:	US
Telephone Number	:	954-972-9393
Fax Number	:	954-979-9303

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	04/07/2008

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