Provider Demographics
NPI:1831370329
Name:JON D. VOGEL, O.D. A PROFESSIONAL CORP
Entity type:Organization
Organization Name:JON D. VOGEL, O.D. A PROFESSIONAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:D
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-208-3011
Mailing Address - Street 1:1059 GAYLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3401
Mailing Address - Country:US
Mailing Address - Phone:310-208-3011
Mailing Address - Fax:310-208-6831
Practice Address - Street 1:1059 GAYLEY AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3401
Practice Address - Country:US
Practice Address - Phone:310-208-6831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP5343152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW22097Medicare PIN
CAOP5343Medicare UPIN