Provider Demographics
NPI:1962685297
Name:THOMAS WILLIAM VOGLEWEDE
Entity Type:Organization
Organization Name:THOMAS WILLIAM VOGLEWEDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY CARE PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:VOGLEWEDE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:276-783-6262
Mailing Address - Street 1:1247 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4311
Mailing Address - Country:US
Mailing Address - Phone:276-783-6262
Mailing Address - Fax:276-783-2295
Practice Address - Street 1:1247 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4311
Practice Address - Country:US
Practice Address - Phone:276-783-6262
Practice Address - Fax:276-783-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601000944152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9204661Medicaid
VAT-21967Medicare UPIN
VA9204661Medicaid
VA580953739Medicare PIN