Provider Demographics
NPI:1770784936
Name:DAVID A BOGAN OD PC
Entity type:Organization
Organization Name:DAVID A BOGAN OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-852-4751
Mailing Address - Street 1:480 E. NORTHFIELD DRIVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2435
Mailing Address - Country:US
Mailing Address - Phone:317-852-4751
Mailing Address - Fax:317-852-4671
Practice Address - Street 1:480 E. NORTHFIELD DRIVE
Practice Address - Street 2:SUITE 600
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2435
Practice Address - Country:US
Practice Address - Phone:317-852-4751
Practice Address - Fax:317-852-4671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002028A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN207120Medicare PIN