Provider Demographics
NPI:1871809012
Name:VOGEL, PHILLIP
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:VOGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41800 WASHINGTON ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BERMUDA DUNES
Mailing Address - State:CA
Mailing Address - Zip Code:92203-8150
Mailing Address - Country:US
Mailing Address - Phone:760-345-3937
Mailing Address - Fax:760-360-5029
Practice Address - Street 1:41800 WASHINGTON ST
Practice Address - Street 2:SUITE 107
Practice Address - City:BERMUDA DUNES
Practice Address - State:CA
Practice Address - Zip Code:92203-8150
Practice Address - Country:US
Practice Address - Phone:760-345-3937
Practice Address - Fax:760-360-5029
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD6449156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician