Provider Demographics
NPI:1114915600
Name:VOGEL, MARK S (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:VOGEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:285 SILLS RD
Mailing Address - Street 2:SUITE 4C
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4869
Mailing Address - Country:US
Mailing Address - Phone:631-654-2020
Mailing Address - Fax:631-654-0606
Practice Address - Street 1:285 SILLS RD
Practice Address - Street 2:SUITE 4C
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4869
Practice Address - Country:US
Practice Address - Phone:631-654-2020
Practice Address - Fax:631-654-0606
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003491152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00338129Medicaid
NY00338129Medicaid
NYT49011Medicare UPIN