Provider Demographics
NPI:1013172188
Name:SHEILA BOGART OD PC
Entity Type:Organization
Organization Name:SHEILA BOGART OD PC
Other - Org Name:BOGART-SMITH OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGART
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:219-663-5960
Mailing Address - Street 1:321 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3250
Mailing Address - Country:US
Mailing Address - Phone:219-663-5960
Mailing Address - Fax:219-663-2398
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:46307-3250
Practice Address - Country:US
Practice Address - Phone:219-663-5960
Practice Address - Fax:219-663-2398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002529A152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU32496Medicare UPIN
IN257860AMedicare PIN
IN6244330001Medicare NSC