Provider Demographics
NPI:1902859812
Name:BOGART, SHEILA KAY (OD)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:KAY
Last Name:BOGART
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 EDGEWATER RD
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8255
Mailing Address - Country:US
Mailing Address - Phone:219-662-3848
Mailing Address - Fax:
Practice Address - Street 1:321 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307
Practice Address - Country:US
Practice Address - Phone:219-663-5960
Practice Address - Fax:219-663-2398
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG004111152W00000X
IN18002529A152W00000X
WI2413-35152W00000X
IN18002529B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU32496Medicare UPIN
IN250340-BMedicare PIN