Provider Demographics
NPI:1528004272
Name:VOGELPOHL, THOMAS ARTHUR (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ARTHUR
Last Name:VOGELPOHL
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 1:1540 HUMBOLDT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-3417
Mailing Address - Country:US
Mailing Address - Phone:651-457-2020
Mailing Address - Fax:651-457-0368
Practice Address - Street 1:1540 HUMBOLDT AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3417
Practice Address - Country:US
Practice Address - Phone:651-457-2020
Practice Address - Fax:651-457-0368
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1789152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN835823100Medicaid
MN835823100Medicaid
MN410001240Medicare ID - Type Unspecified