Provider Demographics
NPI:1831237304
Name:GREGORY CAGLE, O.D., P.A.
Entity type:Organization
Organization Name:GREGORY CAGLE, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-681-5151
Mailing Address - Street 1:1006 MALLOW WAY
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2955
Mailing Address - Country:US
Mailing Address - Phone:813-685-0590
Mailing Address - Fax:
Practice Address - Street 1:1016 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-4572
Practice Address - Country:US
Practice Address - Phone:813-681-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-04
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K5996Medicare ID - Type Unspecified
FL5170290001Medicare NSC