Provider Demographics
NPI:1285953844
Name:MOGIL, JILL (OD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MOGIL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:MIROWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 11805
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-0605
Mailing Address - Country:US
Mailing Address - Phone:888-376-6445
Mailing Address - Fax:314-312-6984
Practice Address - Street 1:2821 N BALLAS RD STE C11
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2313
Practice Address - Country:US
Practice Address - Phone:833-376-6445
Practice Address - Fax:314-312-6984
Is Sole Proprietor?:No
Enumeration Date:2010-05-21
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007879152W00000X
MOTO2571152W00000X
MOT02571152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO991722003OtherMEDICARE PART B
0009359551OtherAETNA
1285953844OtherPROVIDER NPI NUMBER
1285953844OtherPROVIDER NPI NUMBER