Provider Demographics
NPI:1053304618
Name:VOGLEWEDE, THOMAS WILLIAM (OD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WILLIAM
Last Name:VOGLEWEDE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4311
Mailing Address - Country:US
Mailing Address - Phone:276-783-6262
Mailing Address - Fax:276-783-2295
Practice Address - Street 1:1247 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4311
Practice Address - Country:US
Practice Address - Phone:276-783-6262
Practice Address - Fax:276-783-2295
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601000944152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009204661Medicaid
T21967Medicare UPIN
VA009204661Medicaid