Healthcare Provider Details

I. General information

NPI: 1073548848
Provider Name (Legal Business Name): DAVID ALLEN BOGAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 E. NORTHFIELD DRIVE SUITE 600
BROWNSBURG IN
46112-2435
US

IV. Provider business mailing address

480 E. NORTHFIELD DRIVE SUITE 600
BROWNSBURG IN
46112-2435
US

V. Phone/Fax

Practice location:
  • Phone: 317-852-4751
  • Fax: 317-852-4671
Mailing address:
  • Phone: 317-852-4751
  • Fax: 317-852-4671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18002028A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: