Provider Demographics
NPI:1336159755
Name:VOGEL, EMILY L (OD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:L
Last Name:VOGEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:L
Other - Last Name:LIVIERATOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:O D
Mailing Address - Street 1:10921 WILSHIRE BLVD
Mailing Address - Street 2:STE 900
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4003
Mailing Address - Country:US
Mailing Address - Phone:310-453-8911
Mailing Address - Fax:310-453-2519
Practice Address - Street 1:450 N ROXBURY DR FL 3
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4238
Practice Address - Country:US
Practice Address - Phone:310-453-8911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA(OPT) 12453152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA(OPT) 12453OtherSTATE LICENSE
CAW14005OtherASSIL EYE INSTITUTE GROUP MEDICARE
CAML1278666OtherDEA