Provider Demographics
NPI:1922100056
Name:GOGEL, SHELLEY I (LDO)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:I
Last Name:GOGEL
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 LYONS RD
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-3927
Mailing Address - Country:US
Mailing Address - Phone:954-972-9393
Mailing Address - Fax:954-979-9303
Practice Address - Street 1:1311 LYONS RD
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-3927
Practice Address - Country:US
Practice Address - Phone:954-972-9393
Practice Address - Fax:954-979-9303
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO-4618156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1312560001Medicare NSC