Provider Demographics
NPI:1326150541
Name:POGGIOLO, JOHN CARL (OD DR OF OPTOMETRY)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CARL
Last Name:POGGIOLO
Suffix:
Gender:M
Credentials:OD DR OF OPTOMETRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28532 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088
Mailing Address - Country:US
Mailing Address - Phone:586-777-0060
Mailing Address - Fax:586-777-1501
Practice Address - Street 1:28532 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088
Practice Address - Country:US
Practice Address - Phone:586-777-0060
Practice Address - Fax:586-777-1501
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002488152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T33214Medicare UPIN
MIOE06565Medicare ID - Type Unspecified