MEDICARE: DEREK PAUL VOGELPOHL O.D.

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
1	152W00000X	Optometrist	046010660	IL
2	152W00000X	Optometrist	002587	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073951612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK PAUL VOGELPOHL O.D.

Provider Business Mailing Address
First Line	:	1001 AVENUE H STE 2
Second Line	:
City	:	FORT MADISON
State	:	IA
Zip	:	52627-4559
Country	:	US
Telephone Number	:	319-316-6016
Fax Number	:	319-669-8335

Provider Business Practice Location Address
First Line	:	1001 AVENUE H STE 2
Second Line	:
City	:	FORT MADISON
State	:	IA
Zip	:	52627-4559
Country	:	US
Telephone Number	:	319-316-6016
Fax Number	:	319-669-8335

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2013
Last Update Date	:	01/13/2021

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