Organization Name: | JOEL K SHUGAR MD PA |
NPI Number: | 1003970070 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHARLES SCOTT KEELER (MANAGING EMPLOYEE/CEO) |
Mailing Address: | 555 N Byron Butler Pkwy Perry |
State: | FL US |
Postal Code: | 323472315 |
Phone Number: | 8505842778 |
Fax Number: | 8505842790 |
NPI Enumeration Date: | 12/21/2006 |
NPI Last Update Date: | 08/07/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |