Provider Demographics
NPI:1558350967
Name:VOGEL, GARY L (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:VOGEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3540 N BELT W
Mailing Address - Street 2:SUITE C
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5975
Mailing Address - Country:US
Mailing Address - Phone:618-235-4433
Mailing Address - Fax:618-235-7483
Practice Address - Street 1:3540 N BELT W
Practice Address - Street 2:SUITE C
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5975
Practice Address - Country:US
Practice Address - Phone:618-235-4433
Practice Address - Fax:618-235-7483
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL467032152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
183001OtherHEALTH LINK
2203225OtherUNITED HEALTH CARE
5480306OtherAETNA
108161OtherALLIANCE CHOICE
8232096OtherILLINOIS
108161OtherBLUE CHOICE
401171OtherGHP ADVANTIVE
8232096OtherILLINOIS
108161OtherALLIANCE CHOICE
108161OtherBLUE CHOICE
183001OtherHEALTH LINK