Provider Demographics
NPI:1245219583
Name:VOGEL, JON D (OD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:D
Last Name:VOGEL
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 1:1059 GAYLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3401
Mailing Address - Country:US
Mailing Address - Phone:310-208-3011
Mailing Address - Fax:310-208-6831
Practice Address - Street 1:1059 GAYLEY AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3401
Practice Address - Country:US
Practice Address - Phone:310-208-3011
Practice Address - Fax:310-208-6831
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP5343T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT09959Medicare UPIN
CAOP5343Medicare PIN