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Carl Vincent Poggiolo

Optometrist

Eye and Vision Services Providers

15055 22 Mile Rd Ste 3, Shelby Township, MI 48315-4401

PECOS Enrollment

This provider is enrolled in PECOS as CARL POGGIOLO.

Based on the most recent information from CMS, provider Carl Vincent Poggiolo is legally eligible to order and refer claims for Part B, HHA and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1316059538
Provider Type
Individual
Full Name
Poggiolo, Carl Vincent
Title
Dr.
Credential
OD

Gender
Male
Sole Proprietor
No
Enumeration Date
9/1/2006
Last Updated
3/11/2017

Contact Information

Practice Location

15055 22 Mile Rd Ste 3, Shelby Township, MI 48315-4401

(586) 239-0303

(586) 436-3537

Mailing Location

15055 22 Mile Rd Ste 3, Shelby Township, MI 48315-4401

(586) 239-0303

(586) 436-3537

Provider Taxonomies

Code	Description	License
Code 152W00000X Primary	Description Optometrist Eye and Vision Services Providers	License 4901004394 Michigan

Provider Identifiers

ID	Description	Issuer
ID 5189515	Description Medicaid	Issuer Unlisted Michigan
ID 5819551	Description Medicaid	Issuer Unlisted Michigan

Carl Vincent Poggiolo

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

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