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NPI Code Detail

MEDICARE: JON D. VOGEL, O.D. A PROFESSIONAL CORP

MEDICARE: JON D. VOGEL, O.D. A PROFESSIONAL CORP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOP5343CA

General Provider Information

NPI Number : 1831370329
Entity Type Code : Organization
Provider Name (Legal Business Name) : JON D. VOGEL, O.D. A PROFESSIONAL CORP
Provider Business Mailing Address
First Line : 1059 GAYLEY AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90024-3401
Country : US
Telephone Number : 310-208-3011
Fax Number : 310-208-6831
Provider Business Practice Location Address
First Line : 1059 GAYLEY AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90024-3401
Country : US
Telephone Number : 310-208-6831
Fax Number :
Authorized Official
Title or Position : OPTOMETRIST/PRESIDENT
Name : DR. JON D. VOGEL
Credential : O.D.
Telephone Number : 310-208-3011
Provider Enumeration Date : 11/26/2007
Last Update Date : 12/03/2014

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