Provider Demographics
NPI:1073548848
Name:BOGAN, DAVID ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALLEN
Last Name:BOGAN
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 1:480 E. NORTHFIELD DRIVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2435
Mailing Address - Country:US
Mailing Address - Phone:317-852-4751
Mailing Address - Fax:317-852-4671
Practice Address - Street 1:480 E. NORTHFIELD DRIVE
Practice Address - Street 2:SUITE 600
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2435
Practice Address - Country:US
Practice Address - Phone:317-852-4751
Practice Address - Fax:317-852-4671
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002028A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN207120AMedicare ID - Type Unspecified
INT69252Medicare UPIN